1. Christian SWright, Jia Li, WayneW Campbell
Purdue University
Department of Nutrition Science,West Lafayette, IN US
Laboratory of Exercise, Aging, & Nutrition
2. Ogden CL et al, JAMA, 2014
CaoYH, Nat Rev Drug, 2010
Peeters A, Ann Intern Med, 2004
Willamson DF et al, Am J Epidn 1995
15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%
CA
MT
ID
NV
UT
AZ
NM
WY
WA
OR
CO
NE
ND
SD
TX
OK
KS
IA
MN
AR
MO
LA
MI
IN
KY
IL
OH
TN
MS AL
WI
PA
WV
SC
VA
NC
GA
FL
NY
VT
ME
HI
AK
NH
MA
RI
CT
NJ
DE
MD
DC
PRGUAM
2013
CVD
Cancer
Inflammation
Diabetes
Quality of life
Life expectancy
Weight loss
20% all-cause mortality
3. Wycherley TP et al, AJCN 2012
Z = 3.35, P=0.0008
Fat Mass (kg)
HP Diet Greater Fat Mass & Less Fat-Free Mass Loss
HP:
1.0-1.4g•kg-1•d-1
4. Wycherley TP et al, AJCN 2012
Z = 3.35, P=0.0008Z = 2.94, P=0.003
Fat-Free Mass (kg)
HP Diet Greater Fat Mass & Less Fat-Free Mass Loss
HP:
1.0-1.4g•kg-1•d-1
5. Adapated from Fig. 1 in Ensrud KE et al, JCEM 2005
N=1342 Older men
MrOs Cohort
-2.2
-1.8
-1.4
-1
-0.6
-0.2
0.2
0.6
Trying to LoseWeight
(n=470)
Not Trying to LoseWeight
(n=735)
Weight Loss
Stable Weight
Weight gain
∆TotalHipBMD,g/cm2
* *
*p-value < 0.001
Zibellini J et al 2015 – Meta-Analysis
• Hip BMD & Total BMD
6. Soft Tissue – Fat Mass Loss > Lean Mass Loss
Acid-Ash Hypothesis
Darling AL et al (2009)
Dietary protein Spine BMD: +0.02 g/cm2, p=0.04
Exacerbate or Attenuate?
Protein Intake Bone massSAA Intake
Wycherley TP et al, AJCN 2012
Sherman HC, J Biol Chem 1920
Darling AL, AJCN, 2009
7. Using a meta-analysis approach, what is the
effect of dietary protein on bone quantity in
healthy adults during weight loss?
A high protein diet attenuates weight-loss
induced bone loss in healthy adults more
than a normal protein diet.
8. Population
Adults (>19 yrs)
Exclusion criteria
CVDS, diabetes, impaired renal or liver
Medications affecting bone metabolism
Involuntary weight loss or bariatric surgery
Intervention
Protein quantity
Total intake, % energy, or g•kg-1•d-1
Prescribed energy deficient
Diet-induced and/or Exercise-induced
Comparisons
High Protein (HP) vs. Normal Protein (NP)
HP: ≥25% protein or ≥1.0 g•kg-1•d-1
NP: <25% protein or <1.0 g•kg-1•d-1
9. 50-75% usual protein intake (NHANES)
Lack of body composition change
Protein Intake (g•kg-1•d-1)
ΔLeanMass(kg)
1.0
N = 106
Berner LA et al, J Acad Nutr Diet, 2013
Campbell WW et al, J Am Coll Nutr 2007
10. Outcome
Bone Quantity = Bone mineral density (BMD) or content (BMC)
Study Design
Randomized controlled trials or prospective cohort, ≥ 3 months
Search Strategy - July to Nov 2015
Pubmed, CINAHL, Scopus,Web of Science, Cochrane
‘Human’ & ‘English’ filters applied with MeSH terms & keywords
CONSORT Guidelines: Collecting, Evaluating and Excluding/Including
Independently conducted by two scientist - CSW & JL
Bias Assessment
Modified Cochrane tool - Selection, Performance, Detection bias
Analysis
STATA/SE Software, version 12
Changes in bone quantity
11. Articles identified through PubMed,
Cochrane, CINAHL Scopus, and Web of
Science searching
(n=1799)
Records after duplicates removed
(n=1314)
Additional articles identified
from other sources
(n=16)
Abstracts screened for eligibility
(n=1314)
Duplicates excluded
(n=501)
Articles include in qualitative synthesis
(n = 29)
Full-text articles excluded due to
study length or lack of bone and/or
protein quantity data
(n=52)
Articles included in meta-analysis
(n = 10)
IdentificationScreeningEligibilityIncluded
Total BMD
(n=9)
Total articles identified
(n=1815)
Articles excluded
(n=1189)
Full-text articles assessed for eligibility
(n = 125)
Total BMC
(n=8)
Lumbar BMD
(n=6)
Lumbar BMC
(n=4)
Hip BMD
(n=2)
FN BMD
(n=5)
FN BMC
(n=4)
12. Meta-Analysis of 10 RCTs Length N Men Women Age Menopausal status
Skov AR, Obes Res, 2002 6-month 50 12 38 40 Pre
Brehm BJ, JCEM, 2005 4-month 40 0 40 43 Pre
Clifton PM, AJCN, 2008 3-month 73 0 73 50 Pre
CampbellWW, J Gerontol, 2010 3-month 28 0 28 56 Post
Li Z, Nutr J, 2010 1-year 70 21 49 49 Pre
Sukumar D, JBMR, 2011 1-year 47 0 47 58 Post
Josse AR, JCEM, 2012 4-month 81 0 81 28 Pre
Jesudason D, AJCN, 2013 2-year 137 0 137 60 Post
Liu X, BJN, 2013 3-month 48 0 48 48 Pre
Tang M, Nutr Res, 2013 3-month 88 43 45 49 Pre
Largely middle-aged women (76 men, N=662)
Largely Caucasian
Liu X, 2013 - Asian population
Post-menopausal women (n=3)
Diet-induced weight loss
One exercise intervention – Josse AR, 2012
17. A higher protein diet does not exacerbate nor attenuate
weight-loss induced bone loss in middle-aged women.
Possible attenuation of lumbar BMD via a higher protein
diet is apparent, however clinical relevance is
questionable.
Higher protein diets can be used for weight loss without
negatively influencing bone health.
18. Principal Investigator
Wayne Campbell, PhD
Co-Investigator
Jia Li, MS
Funding Sources
USDA Obesity Doctoral Fellowship
Campbell Lab
• Jing Zhou
• Jia Li, MS
• Akua Amnakwaah, MS
• Lauren O’Connor
• Josh Hudson
• Rob Bergia, MS
• Jan Green
