Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. WHEY PROTEIN AND SATIETY IN HUMANS A thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Sciences at Massey University, Manawatu campus, Palmerston North, New Zealand. Sylvia Mee Siong Chung Chun Lam 2013 i Abstract Protein is the most satiating macronutrient and there is an effect of dietary protein source, with dairy whey protein being particularly effective in promoting satiety in adult humans. The underlying cause for this remains to be elucidated. The objectives were to confirm that whey protein is more satiating than maltodextrin carbohydrate in adult humans, to understand the potential mediating factors and to investigate which characteristic of whey protein gives rise to its satiating effect. Ad libitum food intake at a subsequent test meal after administration of a preload, subjective feelings of appetite (using visual analogue scales) and plasma concentrations of satiety-related hormones and metabolites were determined. Preload diets enriched with whey protein induced a greater reduction in subsequent food intake and suppression in rated feelings of appetite compared with maltodextrin carbohydrate (p<0.05). The time of consumption of the whey protein preload did not influence the satiety response. Plasma concentrations of pancreatic polypeptide hormone, total amino acids, and the branched-chain amino acids appear to play an important role in mediating the satiating effect of whey protein (sustained increases from 15 to 120 min following preload consumption, p<0.05). To determine the underlying characteristic of whey protein causing the satiating effect, the effects on satiety of whey protein components (glycomacropeptide, alpha-lactalbumin, or beta- lactoglobulin) and a free amino acid mixture simulating the amino acid composition of the whey protein were compared with that of the intact whey protein. The amino acid composition of whey protein per se appears to be important in the regulation of food intake and the induction of satiety. The individual constituent proteins or whey protein itself did not promote higher satiety than that found based on providing the free amino acids. The absorbed amino acid profile would appear to play an important role in mediating the satiating effect of whey protein. ii Acknowledgements This PhD was undertaken at the Riddet Institute (formerly Riddet Centre) and the Institute of Food, Nutrition and Human Health (IFNHH), at Palmerston North, New Zealand. I extend my sincerest gratitude to my supervision team: Distinguished Professor Paul J. Moughan, for welcoming me on his nutrition team and all his guidance as my chief supervisor, Dr Sharon J. Henare for taking over the role of supervision from Dr. Ajay Awati and for her encouragement and the helpful discussions, and Dr Siva Ganesh (AgResearch Grasslands Research Centre) for his statistical input and inspiring me to look at my data in a different manner. I would like to gratefully acknowledge the Massey University Human Ethics Committee for approval of my human trials (Protocol no. 06/59, 08/38 and 11/47). I would like to thank Dr Mark Williams and Mrs Rosalind Timms (Massey Medical Centre), Mrs Maria-Tine Biersteker and Mrs Chris Booth (IFNHH) for their assistance with my human trials. I am thankful for Ying Jin, Christina Streicher, Jacinta Lee, Heleen van Dijke, Chanapha (Nok) Sawatdeenaruenat, Natascha Strobinger, Mehak Dhillon, and Sumon Saha for their technical support with my human trials. I would also like to thank Professor Marlena Kruger (IFNHH) for the use of the Human Nutrition Research Unit for my human trials. A special thanks to the men and women who volunteered to take part in the studies, I am sincerely grateful. I am extremely grateful to Dr Barbara Rolls (Pennsylvania State University, US) for her advice in the design and conduct of my first study (Chapter 2). I also express my deep sense of gratitude to Associate Professor Hugh R. Morton (School of Sports and Exercise, Massey University) for his valuable advice on statistical analysis and support in the publication of my first journal article (Chapter 2, Physiology & Behavior, 2009, 96, 162–8). iii I am thankful to the Massey University Animal Ethics Committee for approval for my rat trial (Protocol no. 12/07). I would like to extend my thanks to Associate Professor Craig Johnson (Institute of Veterinary, Animal and Biomedical Sciences, Massey University) for his valuable support in receiving approval. I am thankful to Dr Carlos Montoya, Dr Jason Hindmarsh and Mr Trent Olson for their assistance. I would like to thank everyone at the Riddet Institute for their support during my PhD, in particular Dr Shane Rutherfurd for his scientific advice on amino acid determination and input for the manuscript, Dr Derek Haisman and Mr Vikas Mittal for their guidance with product formulation, Miss Maggie Zou for her valuable assistance in performing the determination of amino acid in plasma samples and Dr Prabhu Balan for his kind support in preparing the ELISA assays and providing me with his dissertation. I am also thankful to all based at the Institute of Food Nutrition and Human Health for their help, especially Mrs Fliss Jackson, Miss Leiza Turnbull and Mrs Elizabeth Maforimbo for chemical analysis and Mr Garry Radford and Mr Warwick Johnson for the use of the food laboratories. I am extremely thankful to New Zealand Starch Ltd. for providing me with free samples of maltodextrins, Fonterra Co-operative Group Ltd. for supplying me with free samples of whey protein isolates, Davisco Foods International Inc. for providing free samples of glycomacropeptide, alpha-lactalbumin and beta- lactoglobulin and Evonik Industries AG for the enormous donation of individual pure free amino acids. I am truly thankful to the Riddet Institute for the financial support through a PhD Riddet Scholarship award and funding for my PhD research as part of the Centre of Research Excellence projects. I also thank the Riddet Institute and New Zealand Nutrition Society for their assistance with conference attendance. I would not have completed my PhD without the love and blessings from my family and friends. I am extremely thankful to my parents Joseph and Elie iv Chung Chun Lam for their constant love and support, to my siblings: Cathy, Juliana and Bryan for their encouragement and to my parents-in-law Ross and Suzanne Lawrence for their motivation and support during this PhD journey. My greatest thanks go to my husband, James Lawrence who gave me the strength and encouragement to complete this PhD research. I am dedicating my PhD dissertation to my son, Wesley Lawrence. Thank You. v Table of contents Abstract .............................................................................................. i Acknowledgements ........................................................................... ii Table of contents .............................................................................. v List of Tables ................................................................................... xi List of Figures ............................................................................... xiv List of Abbreviations ..................................................................... xvi Preface .............................................................................................. 1 Chapter 1 .......................................................................................... 1 Review of literature ...................................................................................... 1 1.1. Introduction ...................................................................................... 2 1.2. Satiety................................................................................................. 3 1.2.1. Terminology ............................................................................... 3 1.2.2. Measurement of satiety ............................................................... 5 1.2.2.1. Rating scales ........................................................................... 5 1.2.2.2. Food intake ............................................................................. 6 1.2.3. Experimental designs .................................................................. 8 1.2.4. Satiating capacity of foods.......................................................... 9 1.3. Protein and satiety .......................................................................... 10 1.3.1. Effects of protein intake on satiety ........................................... 10 1.3.2. Mechanisms by which protein intake affects food intake and satiety ................................................................................. 23 1.3.2.1. Energy expenditure ............................................................... 24 1.3.2.2. Amino acids .......................................................................... 26 1.3.2.3. Satiety-related hormones ...................................................... 26 vi 1.3.2.3.1. Ghrelin ................................................................................... 27 1.3.2.3.2. Cholecystokinin ..................................................................... 28 1.3.2.3.3. Glucagon-like peptide-1 ........................................................ 29 1.3.2.3.4. Peptide YY ............................................................................ 29 1.4. Whey protein and satiety ................................................................ 31 1.4.1. Nutritional profile of whey protein ........................................... 31 1.4.2. Effect of whey protein intake on satiety .................................... 33 1.4.2.1. Dose dependent effect ........................................................... 33 1.4.2.2. Whey protein versus casein ................................................... 34 1.4.2.3. Whey protein versus other protein sources ........................... 35 1.4.2.4. Whey protein versus carbohydrate ........................................ 36 1.4.3. Mechanisms of action of whey protein ..................................... 43 1.4.3.1. Protein components ............................................................... 44 1.4.3.2. Glycomacropeptide ............................................................... 44 1.4.3.3. Amino acids ........................................................................... 47 1.5. Conclusions and scope of thesis ...................................................... 48 1.6. Literature cited ................................................................................ 49 Chapter 2 ......................................................................................... 76 The influence of whey protein and glycomacropeptide on satiety in adult humans ............................................................................................... 76 2.1. Abstract ............................................................................................ 77 2.2. Introduction ..................................................................................... 77 2.3. Subjects and methods...................................................................... 80 2.3.1. Subjects ..................................................................................... 80 2.3.2. Design ........................................................................................ 80 2.3.3. Preload drink and lunch meal .................................................... 83 2.3.4. Chemical analysis ...................................................................... 87 2.3.5. Statistical analysis ..................................................................... 88 2.4. Results .............................................................................................. 89 2.4.1. Subject characteristics ............................................................... 89 2.4.2. Satiety ratings (VAS) ................................................................ 89 vii 2.4.3. Drink palatability ...................................................................... 90 2.4.4. Food and water intake ............................................................... 93 2.4.5. Correlation analyses.................................................................. 98 2.5. Discussion ...................................................................................... 101 2.6. Literature cited ............................................................................. 104 Chapter 3 ...................................................................................... 109 Effect of time of consumption of preloads on measures of satiety in healthy normal weight women ................................................................. 109 3.1. Abstract ......................................................................................... 110 3.2. Introduction .................................................................................. 110 3.3. Subjects and methods ................................................................... 112 3.3.1. Subjects ................................................................................... 112 3.3.2. Preload drinks and test meal ................................................... 113 3.3.3. Experimental procedure .......................................................... 115 3.3.4. Measurements ......................................................................... 116 3.3.5. Statistical analysis ................................................................... 117 3.4. Results ............................................................................................ 118 3.4.1. Study subjects ......................................................................... 118 3.4.2. Sensory ratings of the preload drinks ..................................... 119 3.4.3. Drinking and eating time ........................................................ 121 3.4.4. Water intake ............................................................................ 121 3.4.5. Ad libitum test meal intake ..................................................... 121 3.4.6. Total energy intake ................................................................. 122 3.4.7. Reported food intake for the remainder of the day and full 24h intake ............................................................................... 124 3.4.8. Subjective ratings of appetite.................................................. 127 3.4.9. Nausea..................................................................................... 128 3.5. Discussion ...................................................................................... 132 3.5.1. Energy intake .......................................................................... 132 3.5.2. Study design ........................................................................... 135 3.5.3. Conclusion .............................................................................. 136 viii 3.6. Literature cited .............................................................................. 137 Chapter 4 ....................................................................................... 142 Dietary whey protein influences plasma satiety-related hormones and plasma amino acids in adult women ................................................ 142 4.1. Abstract .......................................................................................... 143 4.2. Introduction ................................................................................... 143 4.3. Subjects and methods.................................................................... 145 4.3.1. Subjects ................................................................................... 145 4.3.2. Test diets ................................................................................. 148 4.3.3. Experimental procedure .......................................................... 148 4.3.4. Blood sample collection and analysis ..................................... 149 4.3.5. Statistical analysis ................................................................... 151 4.4. Results ............................................................................................ 151 4.4.1. Glucose and Insulin ................................................................. 151 4.4.2. Active Ghrelin ......................................................................... 152 4.4.3. Leptin ...................................................................................... 152 4.4.4. Gastrointestinal hormones ....................................................... 155 4.4.5. Correlations between plasma hormones .................................. 156 4.4.6. Urea and ammonia .................................................................. 160 4.4.7. Plasma amino acids ................................................................. 160 4.5. Discussion ....................................................................................... 166 4.6. Literature cited .............................................................................. 170 Chapter 5 ....................................................................................... 177 The underlying cause of the satiating effect of whey protein: effect of whey protein and glycomacropeptide isolate on measures of satiety in normal-weight adult women .................................................... 177 5.1. Abstract .......................................................................................... 178 5.2. Introduction ................................................................................... 178 5.3. Subjects and methods.................................................................... 180 5.3.1. Subjects ................................................................................... 180 ix 5.3.2. Preloads and test meal ............................................................ 181 5.3.3. Experimental procedure .......................................................... 184 5.3.4. Statistical analysis ................................................................... 185 5.4. Results ............................................................................................ 187 5.4.1. Palatability of the preloads and test meal ............................... 187 5.4.2. Ad libitum food intake at lunch ............................................... 189 5.4.3. Subjective ratings of appetite and nausea ............................... 191 5.4.4. Correlation analyses................................................................ 195 5.5. Discussion ...................................................................................... 195 5.6. Literature cited ............................................................................. 199 Chapter 6 ...................................................................................... 203 Amino acid content of a whey protein isolate: determined using multiple hydrolysis times ......................................................................... 203 6.1. Abstract ......................................................................................... 204 6.2. Introduction .................................................................................. 204 6.3. Materials and methods ................................................................. 206 6.3.1. Sample .................................................................................... 206 6.3.2. Tryptophan analysis ................................................................ 206 6.3.3. Sulphur amino acid analysis ................................................... 207 6.3.4. Analysis of the ‘acid-stable’ amino acids ............................... 207 6.3.5. Prediction of amino acid concentrations................................. 208 6.4. Results ............................................................................................ 209 6.5. Discussion ...................................................................................... 215 6.6. Literature cited ............................................................................. 216 Chapter 7 ...................................................................................... 219 The underlying cause of the satiating effect of whey protein: effect of whey protein components and a free amino acid mixture simulating whey protein on measures of satiety in adult women ......... 219 7.1. Abstract ......................................................................................... 220 x 7.2. Introduction ................................................................................... 220 7.3. Subjects and methods.................................................................... 223 7.3.1. Subjects ................................................................................... 223 7.3.2. Test foods ................................................................................ 224 7.3.3. Experimental procedure .......................................................... 229 7.3.4. Questionnaires ......................................................................... 230 7.3.5. Statistical analyses ................................................................... 230 7.4. Results ............................................................................................ 231 7.4.1. Palatability of the preload meals ............................................. 232 7.4.2. Ad libitum test meal intake and total energy intake ................ 234 7.4.3. Subjective ratings of appetite .................................................. 237 7.4.4. Correlation anlyses .................................................................. 240 7.5. Discussion ....................................................................................... 240 7.6. Literature cited .............................................................................. 244 Chapter 8 ....................................................................................... 250 General Discussion and Conclusion ......................................................... 250 8.1. Conclusions .................................................................................... 259 8.2. Recommendations for future research ........................................ 260 8.3. Literature cited .............................................................................. 261 Appendices .................................................................................... 267 Appendix 1 .................................................................................... 268 Whey protein and satiety: implications for diet and behavior .............. 268 Appendix 2 .................................................................................... 287 xi List of Tables Table 1.1. Effects of dietary protein on food intake and subjective ratings of appetite in normal-weight adult humans. .................................. 13 Table 1.2. Effects of dietary protein source on food intake and subjective ratings of appetite in adult humans. ............................................... 37 Table 2.1. Ingredient (g as-is basis) and nutrient (per 300ml) compositions of the preload drinks. ..................................................................... 84 Table 2.2. Effect of preload drink on food, specific nutrient (weight or percentage of total food energy intake) and water intake at lunch 30 min after administration of preload (Mean; n = 50). ...... 94 Table 2.3. Effect of preload drink on food, water and nutrient intakes at lunch in men and women (Mean) .................................................. 96 Table 3.1. Composition of the preload drinks. ............................................... 114 Table 3.2. Effects of preload drink and time delay on water, test meal and total (preload + test meal) energy intakes in women (Mean; n = 19). ............................................................................................ 123 Table 3.3. Effect of preload drink on food energy and nutrient intakes for the “remainder of the day” and “over the whole of the day” (breakfast + preload + test meal + remainder of the day; 24 hour) at the time delay of 120 minutes (Mean; n = 19). .............. 125 Table 3.4. Effect of preload drink on area under the curves (AUCs) for subjective ratings of appetite at the time delay of 120 minutes (Mean; n = 19). ............................................................................ 131 Table 3.5. Mean test meal energy intake (kJ) following consumption of three different preload drinks and for time delays of 30, 60, and 120 minutes in ninety women. .............................................. 134 xii Table 4.1. Subject characteristics at baseline (Values are means ± sem, n = 18). ............................................................................................ 147 Table 4.2. Net incremental area under the curve (iAUC) for postprandial responses following consumption of the “carbohydrate”- enriched and “protein”-enriched test drinks. ................................ 159 Table 4.3. Net incremental area under the curve (iAUC) for plasma concentrations of individual amino acids following consumption of the carbohydrate-enriched and protein- enriched test drinks1. .................................................................... 164 Table 5.1. Composition of the four preload drinks. ........................................ 182 Table 5.2. Water intake, ad libitum test meal food (g) and energy (kJ ME) intakes and total (preload + test meal) energy intake after consumption of preloads containing carbohydrate, whey protein isolate with high glycomacropeptide (WPI-high GMP), whey protein isolate with low glycomacropeptide (WPI-low GMP) and glycomacropeptide isolate (GMP). ............................. 190 Table 5.3. Subjective ratings of appetite and nausea expressed as net incremental area under the curve (Net iAUC) following ingestion of preloads containing carbohydrate, whey protein isolate with high glycomacropeptide (WPI-high GMP), whey protein isolate with low glycomacropeptide (WPI-low GMP) and glycomacropeptide isolate (GMP). ........................................ 194 Table 6.1. The amino acid composition (g/100g powder on air-dry basis) of whey protein isolate estimated using a least-squares nonlinear regression model after multiple hydrolysis times (Ao) (mean ± sem), compared with the 24-h hydrolysis value (mean ± sem) and estimated hydrolysis rate (h) (amount of protein- bound amino acid released per hour) (mean ± sem) and loss rate (l) (amount of protein-bound amino acid destroyed per hour) for each amino acid (mean ± sem)1. ................................... 213 Table 7.1. Composition of the four preload meals enriched with whey protein isolate (WPI), alpha-lactalbumin (A-LA), beta- lactoglobulin (B-LG) and a free amino acid mixture simulating the amino acid composition of whey protein isolate (AA). ......... 226 xiii Table 7.2. Palatability scores determined on a 10-cm visual analogue scale for the four preload meals containing either whey protein isolate (WPI), alpha-lactalbumin (A-LA), beta-lactoglobulin (B-LG), or a free amino acid mixture (AA)1. .............................. 233 xiv List of Figures Figure 1.1. Overview of the satiety cascade (reproduced with permission from Halford & Blundell, 2005), including the three levels of operations: (A) neurotransmitter and metabolic interactions in the brain, (B) physiological and metabolic events, and (C) psychological and behavioural events. ............................................. 4 Figure 1.2. Protein composition of bovine milk (Adapted with permission from Walstra et al., 2006). ............................................................. 32 Figure 1.3. The enzyme chymosin breaks down κ-casein into para-κ- casein and caseinomacropeptide (CMP). The latter can undergo glycosylation to form glycomacropeptide (GMP). .......... 45 Figure 2.1. Experimental protocol. ................................................................... 82 Figure 2.2. a)-d). Subjective VAS ratings throughout the study for the different preload drinks: carbohydrate, WPI with naturally present GMP, WPI with added GMP and WPI with no GMP. ...... 92 Figure 2.3. Scatter plot and linear regression line (dashed line) for fullness VAS scores at 30 minutes (cm) plotted as a function of food intake (g) (n = 50). .......................................................................... 99 Figure 3.1. Scatter plots and Pearson correlation between VAS-rated likeability of the carbohydrate (carb, ■) and protein (pro, ▲) preload drinks and amount of food consumed at the lunchtime test meal (g) in nineteen women. .................................................. 120 Figure 4.1. Plasma concentrations of (A) glucose, (B) insulin, (C) ghrelin, and (D) leptin in eighteen normal-weight women in response to ingestion of carbohydrate-enriched (○) and protein-enriched (●) beverages. ............................................................................... 154 xv Figure 4.2. Plasma concentrations of (A) CCK (cholecystokinin), (B) GIP (glucose-dependent insulinotropic polypeptide), (C) GLP-1 (glucagon-like peptide-1), (D) PP (pancreatic polypeptide), and (E) PYY (peptide tyrosine-tyrosine) in eighteen normal- weight women after ingestion of carbohydrate-enriched (○) and protein-enriched (●) beverages. ............................................ 158 Figure 4.3. Plasma concentrations of (A) urea, (B) ammonia, (C) TAA (Total amino acid), and (D) BCAA (Branched-chain amino acid) in normal-weight women in response to consumption of carbohydrate-enriched (○) and protein-enriched (●) beverages. . 163 Figure 5.1. VAS ratings of overall likeability, pleasantness of taste and likeability of texture and overall sweetness for the four preload drinks (Values are means ± sem, n = 22). .................................... 188 Figure 5.2. Mean subjective VAS ratings of hunger, desire to eat, prospective consumption, and fullness in response to ingestion of preload drinks containing carbohydrate, whey protein isolate with high glycomacropeptide (WPI-high GMP), whey protein isolate with low glycomacropeptide (WPI-low GMP) and glycomacropeptide isolate (GMP). ....................................... 193 Figure 6.1. Effect of hydrolysis time (x-axis, h) on the concentration of amino acids (y-axis, g/100g) for whey protein isolate................. 211 Figure 7.1. (A) Amount. (B) Energy. ............................................................ 235 Figure 7.2. VAS-rated subjective feelings of hunger, desire to eat, prospective consumption, and fullness before (baseline, B) and after consumption of the four preload meals, and 15 and 30 min following consumption of the ad libitum test meal. Inset: Net incremental areas under the curve (Net iAUC) from 0 to 120 min in response to the four preload meals. ........................... 239 xvi List of Abbreviations ~ Approximately α Alpha α-la Alpha-lactalbumin β Beta β-lg Beta-lactoglobulin γ Gamma κ Kappa 5-HT Serotonin A-LA Alpha-lactalbumin AA Amino acid ADA American Diabetes Association AgRP Agouti-related peptide AMPK Adenosine monophospate-activated protein kinase ANOVA Analysis of variance AOAC Association of Official Chemists ARN Arcuate nucleus ATP Adenosine triphosphate AUC Area under the curve B-LG Beta-lactoglobulin BCAA Branched-chain amino acid BMI Body mass index BSA Bovine serum albumin C Carbohydrate Carb Carbohydrate xvii CART Cocaine- and amphetamine-regulated transcript CCK Cholecystokinin CMP Caseinomacropeptide CNS Central nervous system CRF Corticotrophin releasing factor DIT Diet-induced thermogenesis DPP-IV Dipeptidyl-peptidase-IV E Energy EAA Essential amino acid EDTA Ethylenediaminetetraacetic acid EFSA European Food Safety Authority ELISA Enzyme-linked immunosorbent assay F Fat FAO Food and Agricultural Organisation FFA Free fatty acids GE Gross energy GIP Glucose-dependent insulinotropic polypeptide GLP-1 Glucagon-like peptide-1 GMP Glycomacropeptide HC High-Carbohydrate HF High-Fat HP High-Protein HPLC High-perfomance liquid chromatography iAUC incremental area under the curve IFNHH Institute of Food, Nutrition and Human Health Ig Immunoglobulin J joule xviii kcal kilocalorie kJ kilojoule MC Melanocortin ME Metabolisable energy MJ megajoules mTOR rapamycin NP Normal-Protein NPY Neuropeptide Y NTS Nucleus tractus solitaries NW Normal-weight OPA o-phthalaldehyde OW Overweight P Protein PKU Phenylketonuria POMC Pro-opiomelanocortin PP Pancreatic polypeptide Pro Protein PYY Peptide tyrosine-tyrosine SE Standard error of mean sem Standard error of mean T/LNAA Tryptophan Large neutral amino acids ratio UNU United Nations University VAS Visual analogue scales WHO World Health Organisation WP Whey protein WPI Whey protein isolate