Associations Between Macronutrient Intake and Self-reported Appetite and Fasting Levels of Appetite Hormones: Results From the Optimal Macronutrient Intake Trial to Prevent Heart Disease

The authors compared effects of macronutrients on self-reported appetite and selected fasting hormone levels. The Optimal Macronutrient Intake Trial to Prevent Heart Disease (OMNI-Heart) (2003-2005) was a randomized, 3-period, crossover feeding trial (n = 164) comparing the effects of 3 diets, each rich in a different macronutrient. Percentages of kilocalories of carbohydrate, fat, and protein were 48, 27, and 25, respectively, for the protein-rich diet; 58, 27, and 15, for the carbohydrate-rich diet; and 48, 37, and 15 for the diet rich in unsaturated fat. Food and drink were provided for each isocaloric 6-week period. Appetite was measured by visual analog scales. Pairwise differences between diets were estimated using generalized estimating equations. Compared with the protein diet, premeal appetite was 14% higher on the carbohydrate (P = 0.01) and unsaturated-fat (P = 0.003) diets. Geometric mean leptin was 8% lower on the protein diet than on the carbohydrate diet (P = 0.003). Obestatin levels were 7% and 6% lower on the protein diet than on the carbohydrate (P = 0.02) and unsaturated-fat (P = 0.004) diets, respectively. There were no between-diet differences for ghrelin. A diet rich in protein from lean meat and vegetables reduces self-reported appetite compared with diets rich in carbohydrate and unsaturated fat and can be recommended in a weight-stable setting. The observed pattern of hormone changes does not explain the inverse association between protein intake and appetite.