Associations of percent energy intake from total, animal and plant protein with overweight/obesity and underweight among adults in Addis Ababa, Ethiopia.

Abstract Objective: This study investigated associations between types and food sources of protein with overweight/obesity and underweight in Ethiopia. Design: We conducted a cross-sectional dietary survey using a non-quantitative FFQ. Linear regression models were used to assess associations between percentage energy intake from total, animal and plant protein and BMI. Logistic regression models were used to examine the associations of percentage energy intake from total, animal and plant protein and specific protein food sources with underweight and overweight/obesity. Setting: Addis Ababa, Ethiopia. Participants: 1624 Ethiopian adults (992 women and 632 men) aged 18–49 years in selected households sampled using multi-stage random sampling from five sub-cities of Addis Ababa. Results: Of the surveyed adults, 31 % were overweight or obese. The majority of energy intake was from carbohydrate with only 3 % from animal protein. In multivariable-adjusted linear models, BMI was not associated with percentage energy from total, plant or animal protein. Total and animal protein intake were both associated with lower odds of overweight/obesity (OR per 1 % energy increment of total protein 0·92; 95 % CI: 0·86, 0·99; P = 0·02; OR per 1 % energy increment of animal protein 0·89; 95 % CI: 0·82, 0·96; P = 0·004) when substituted for carbohydrate and adjusted for socio-demographic covariates. Conclusion: Increasing proportion of energy intake from total protein or animal protein in place of carbohydrate could be a strategy to address overweight and obesity in Addis Ababa; longitudinal studies are needed to further examine this potential association.

[1]  W. Fawzi,et al.  Life expectancy and agricultural environmental impacts in Addis Ababa can be improved through optimized plant and animal protein consumption , 2021, Nature Food.

[2]  W. Fawzi,et al.  Changes and challenges in markets for animal source foods: a qualitative study among market vendors in Addis Ababa, Ethiopia , 2020, Food Security.

[3]  N. Ramankutty,et al.  Livestock policy for sustainable development , 2020, Nature Food.

[4]  J. Wells,et al.  The double burden of malnutrition: aetiological pathways and consequences for health , 2019, The Lancet.

[5]  W. Fawzi,et al.  Anemia prevalence and etiology among women, men, and children in Ethiopia: a study protocol for a national population-based survey , 2019, BMC Public Health.

[6]  A. Hoekstra,et al.  Country-specific dietary shifts to mitigate climate and water crises , 2019, Global Environmental Change.

[7]  E. Feskens,et al.  Methodology for developing and evaluating food-based dietary guidelines and a Healthy Eating Index for Ethiopia: a study protocol , 2019, BMJ Open.

[8]  W. Willett,et al.  Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems , 2019, The Lancet.

[9]  P. Jacques,et al.  Dietary protein and changes in markers of cardiometabolic health across 20 years of follow-up in middle-aged Americans , 2018, Public Health Nutrition.

[10]  H. A. Park,et al.  Animal and Plant Protein Intake and Body Mass Index and Waist Circumference in a Korean Elderly Population , 2018, Nutrients.

[11]  W. Fawzi,et al.  Validity of an FFQ to measure nutrient and food intakes in Tanzania , 2018, Public Health Nutrition.

[12]  D. English,et al.  Dietary protein from different food sources, incident metabolic syndrome and changes in its components: An 11-year longitudinal study in healthy community-dwelling adults. , 2017, Clinical nutrition.

[13]  A. Astrup,et al.  Dietary Intake of Protein from Different Sources and Weight Regain, Changes in Body Composition and Cardiometabolic Risk Factors after Weight Loss: The DIOGenes Study , 2017, Nutrients.

[14]  E. Frongillo,et al.  Diet quality and risk of stunting among infants and young children in low‐ and middle‐income countries , 2017, Maternal & child nutrition.

[15]  M. Naghavi,et al.  National disability-adjusted life years (DALYs) for 257 diseases and injuries in Ethiopia, 1990–2015: findings from the global burden of disease study 2015 , 2017, Population Health Metrics.

[16]  M. E. Hoque,et al.  Double burden of underweight and overweight among Bangladeshi adults differs between men and women: evidence from a nationally representative survey , 2017, Public Health Nutrition.

[17]  Mingyang Song,et al.  Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. , 2016, JAMA internal medicine.

[18]  Claire E. Berryman,et al.  Diets Higher in Animal and Plant Protein Are Associated with Lower Adiposity and Do Not Impair Kidney Function in US Adults , 2016, The American journal of clinical nutrition.

[19]  P. Scarborough,et al.  Analysis and valuation of the health and climate change cobenefits of dietary change , 2016, Proceedings of the National Academy of Sciences.

[20]  A. Taffesse,et al.  Seasonality and household diets in Ethiopia , 2015, Public Health Nutrition.

[21]  S. Poppitt,et al.  Prevention of type 2 diabetes through lifestyle modification: is there a role for higher-protein diets? , 2015, Advances in nutrition.

[22]  H. Lieberman,et al.  Higher-protein Diets Are Associated with Higher Hdl Cholesterol and Lower Bmi and Waist Circumference in Us Adults 1–4 , 2022 .

[23]  U. Colón-Ramos,et al.  The burden of underweight and overweight among women in Addis Ababa, Ethiopia , 2014, BMC Public Health.

[24]  Tilahun Bejitual Zellelew.  Meat abstinence and its positive environmental effect: Examining the fasting etiquettes of the Ethiopian Orthodox Church , 2014 .

[25]  Z. Mchiza,et al.  Obesity and the nutrition transition in Sub‐Saharan Africa , 2014, Annals of the New York Academy of Sciences.

[26]  P. Clifton,et al.  Long term weight maintenance after advice to consume low carbohydrate, higher protein diets--a systematic review and meta analysis. , 2014, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[27]  Zeng-li Zhang,et al.  Effects of high-protein diets on body weight, glycaemic control, blood lipids and blood pressure in type 2 diabetes: meta-analysis of randomised controlled trials. , 2013, The British journal of nutrition.

[28]  G. Brinkworth,et al.  Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials. , 2012, The American journal of clinical nutrition.

[29]  H. Schönfeldt,et al.  Dietary protein quality and malnutrition in Africa , 2012, British Journal of Nutrition.

[30]  R. Uauy,et al.  Assessment of protein adequacy in developing countries: quality matters , 2012, British Journal of Nutrition.

[31]  M. Westerterp-Plantenga,et al.  Dietary protein – its role in satiety, energetics, weight loss and health , 2012, British Journal of Nutrition.

[32]  D. Mozaffarian,et al.  Changes in diet and lifestyle and long-term weight gain in women and men. , 2011, The New England journal of medicine.

[33]  Gretchen A. Stevens,et al.  National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants , 2011, The Lancet.

[34]  I. Huybrechts,et al.  Plant and animal protein intake and its association with overweight and obesity among the Belgian population , 2010, British Journal of Nutrition.

[35]  W. Gulliver,et al.  Clinical Medicine Insights: Endocrinology and Diabetes , 2010 .

[36]  Donald A Williamson,et al.  Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. , 2009, The New England journal of medicine.

[37]  Lilani Kumaranayake,et al.  Constructing socio-economic status indices: how to use principal components analysis. , 2006, Health policy and planning.

[38]  J. Purnell,et al.  A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. , 2005, The American journal of clinical nutrition.

[39]  M. Noakes,et al.  Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. , 2005, The American journal of clinical nutrition.

[40]  Frank B. Hu,et al.  The Effects of High Protein Diets on Thermogenesis, Satiety and Weight Loss: A Critical Review , 2004, Journal of the American College of Nutrition.

[41]  E. Gracely,et al.  A low-carbohydrate as compared with a low-fat diet in severe obesity. , 2003, The New England journal of medicine.

[42]  D. Rader,et al.  A randomized trial of a low-carbohydrate diet for obesity. , 2003, The New England journal of medicine.

[43]  P. Trumbo,et al.  Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. , 2002, Journal of the American Dietetic Association.

[44]  S. Toubro,et al.  Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity , 1999, International Journal of Obesity.

[45]  P. Sands.  The United Nations Framework Convention on Climate Change , 1992 .

[46]  B. Minten,et al.  Consumption of animal-source foods in Ethiopia: Patterns, changes, and determinants , 2018 .

[47]  N. Mcconaghy,et al.  Age and Sex , 1993 .

[48]  M. Singer,et al.  Nutritional Epidemiology , 2020, Definitions.