Ultra-processed foods, protein leverage and energy intake in the USA

Public Health Nutr. 2018 Jan;21(1):114-124. doi: 10.1017/S1368980017001574. Epub 2017 Oct 16.


Objective: Experimental studies have shown that human macronutrient regulation minimizes variation in absolute protein intake and consequently energy intake varies passively with dietary protein density ('protein leverage'). According to the 'protein leverage hypothesis' (PLH), protein leverage interacts with a reduction in dietary protein density to drive energy overconsumption and obesity. Worldwide increase in consumption of ultra-processed foods (UPF) has been hypothesized to be an important determinant of dietary protein dilution, and consequently an ecological driving force of energy overconsumption and the obesity pandemic. The present study examined the relationships between dietary contribution of UPF, dietary proportional protein content and the absolute intakes of protein and energy.

Design: National representative cross-sectional study.

Setting: National Health and Nutrition Examination Survey 2009-2010.

Subjects: Participants (n 9042) aged ≥2 years with at least one day of 24 h dietary recall data.

Results: We found a strong inverse relationship between consumption of UPF and dietary protein density, with mean protein content dropping from 18·2 to 13·3 % between the lowest and highest quintiles of dietary contribution of UPF. Consistent with the PLH, increase in the dietary contribution of UPF (previously shown to be inversely associated with protein density) was also associated with a rise in total energy intake, while absolute protein intake remained relatively constant.

Conclusions: The protein-diluting effect of UPF might be one mechanism accounting for their association with excess energy intake. Reducing UPF contribution in the US diet may be an effective way to increase its dietary protein concentration and prevent excessive energy intake.

Keywords: Dietary protein content; NHANES; Protein leverage hypothesis; Ultra-processed foods.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diet*
  • Dietary Proteins / administration & dosage*
  • Exercise
  • Fast Foods*
  • Food Analysis
  • Food Handling
  • Humans
  • Mental Recall
  • Middle Aged
  • Nutrition Assessment
  • Nutrition Surveys
  • Socioeconomic Factors
  • United States
  • Young Adult


  • Dietary Proteins