Dietary protein and urinary nitrogen in relation to 6-year changes in fat mass and fat-free mass.

BACKGROUND In contrast to the physiological expectation, observational studies show that greater protein intake is associated with subsequent body weight (BW) gain. An increase in fat-free mass (FFM) due to the anabolic effects of protein could explain this. OBJECTIVE To examine associations between protein intake and subsequent changes in fat mass (FM) and FFM in longitudinal, observational data. DESIGN A health examination, including measures of FM and FFM by bioelectrical impedance at baseline and follow-up 6 years later, was conducted. Diet history interviews (DHI) were performed, and 24-h urinary nitrogen collection at baseline was done. In total, 330 participants with DHI, of whom 227 had validated and complete 24-h urine collection data, were analyzed. Macronutrient energy substitution models were used. RESULTS Mean estimated protein intake was 14.6 E% from DHI and 11.3 E% from urinary nitrogen. Estimated from DHI, FM increased 46 g per year, with every 1 E% protein substituted for fat (95% confidence interval (CI) = 13, 79; P = 0.006), and FFM increased 15 g per year (1, 30; P = 0.046). Results were similar in other substitution models. Estimated from urinary nitrogen, FM increased 53 g per year, with 1 E% protein substituted for other macronutrients (24, 81; P < 0.0005), and FFM increased 18 g per year (6, 31; P = 0.004). CONCLUSION Within a habitual range, a greater protein intake was associated with BW gain, mostly in FM. This is in contrast to the expectations based on physiological and clinical trials, and calls for a better understanding of how habitual dietary protein influences long-term energy balance, versus how greater changes in dietary proteins may influence short-term energy balance.