Diet composition, adherence to calorie restriction, and cardiometabolic disease risk modification

Abstract

Calorie restriction (CR) is a promising approach for attenuating the risk of age-related disease. However, the role of diet composition on adherence to CR and the effects of CR on cardiometabolic markers of healthspan remains unknown. We used the Geometric Framework for Nutrition approach to examine the association between macronutrient composition and CR adherence during the 2-year CALERIE trial. Adult participants without obesity were randomized to a 25% CR intervention or an ad libitum intake control. Correlations of cardiometabolic risk factors with macronutrient composition and standard dietary pattern indices [Alternate Mediterranean Diet Index (aMED), Dietary Inflammatory Index (DII), and Healthy Eating Index (HEI)] were also evaluated by Spearman's correlation at each time point. The mean age was 38.1 ± 7.2 years at baseline and the mean BMI was 25.1 ± 1.7. The study population was 70% female. The CR group, but not the control, consumed a higher percentage reported energy intake from protein and carbohydrate and lower fat at 12 months compared to baseline; comparable results were observed at 24 months. Protein in the background of higher carbohydrate intake was associated with greater adherence at 24 months. There was no correlation between macronutrient composition and cardiometabolic risk factors in the CR group. However, statistically significant correlations were observed for the DII and HEI. These findings suggest that individual self-selected macronutrients have an interactive but not independent role in CR adherence. Additional research is required to examine the impact of varying macronutrient compositions on adherence to CR and resultant modification to cardiometabolic risk factors.

Keywords: aging; calorie restriction; human; molecular biology of aging.

FIGURE 1

Right‐angle mixture triangle (RMT) of percentage reported energy from protein (X‐axis), carbohydrate (Y‐axis), and fat (implicit axis) in each group. Black, blue, and red are for baseline, 12‐ and 24‐month visits. Washed out underlying colors are raw data, and sharp colors, the mean. The ellipse is a 95% credible interval. Diagonal black lines are iso‐fat lines.

FIGURE 2

Distribution of adherence to calorie restriction (CR) at 12 (a, b) and 24‐month follow‐up visits (c, d) in the CR and ad libitum (AL) control groups. Percent calorie restriction (a, c) is shown with CR in gray and AL in green. Adherence for the CR participants are shown in (b, d), with adherence calculated as the natural log of the ratio of prescribed energy intake to total energy intake.

FIGURE 3

Association between percentage reported energy from carbohydrate, fat, and protein at 12‐ and 24‐month follow up visits (a, c). Fitted trends are from linear regression to help interpret the sign of the association (coefficients not shown). Right‐angle mixture triangles at each time point (b, d) show the association between percentage reported energy from each macronutrient and adherence. Surface is as estimated by the AIC‐favored model. Red areas indicate high adherence, while blue areas indicate low adherence. Contours indicate the absolute value of adherence score.