Tuesday, March 8, 2016

Path to Fat-Induced Obesity is Sprinkled With Salt - Sodium Boosts Food & Energy Intake & Reduces Fat's Satiety Effect

Think you cannot eat the whole pizza? Add salt - this should "help" with the hardest all-you-can-eat challenges.
I am not telling you something new if I tell you that excess fat consumption has been linked to the development of obesity. I hope that it's also not news to you that the consistent association between high(er) fat intakes and weight gain in epidemiological studies cannot be reproduced in human studies where the diet is just high in fat and doesn't have the perfect "potato chips"-combination of fat and carbohydrate that has not just been proven to increase food intake, but also to have pro-addictive effects on the brain (Hoch. 2015).

The fat to carbohydrate ratio Hoch et al. identified as a crucial determinant of snack food intake and brain reward responses in their 2015 study is yet not the only characteristic feature of potato chips.
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Another similarly striking feature chips share with a couple of other highly addictive foods is their salt content. The same salt content of which Bolhuis et al. write in their soon-to-be-published paper in The Journal of Nutrition that we don't know yet how it interacts with the appetitive effects of fat. Apropos fat, whether fat will increase or decrease your appetite is actually highly individual question. Some studies even suggest that a high fat content has appetite reducing effects - at least in those individuals with a high fat taste sensitivity.

Unfortunately, the results of pertinent studies are inconclusive; and that even in people with intact fat taste sensitivity. In view of previous research showing similar associations between the salt content of snack foods and their appetizing effects as they were observed for high carbohydrate + high fat foosds, Bolhuis et al. speculated that our fat taste sensitivity may be influenced by the co-ingestion of salt. To test this hypothesis, the researchers recruited forty-eight healthy adults [16 men and 32 women, aged 18–54 y, body mass index (kg/m2): 17.8–34.4]. After an initial assessment of their individual fat taste sensitivity, the subjects participated in a randomized 2 x 2 crossover design trial, in which each participant attended 4 lunchtime sessions after a standardized breakfast.

Figure 1: The high salt meals were generally rated as more pleasant, while fat had no effect on the perceived pleasantness of the meal (Bolhuis. 2016).
The meals seemed to be identical elbow macaroni (56%) with sauce (44%); the sauces, however, were manipulated to be
  • low-fat (0.02% fat, wt:wt)/low-salt (0.06% NaCl, wt:wt),
  • low-fat/high-salt (0.5% NaCl, wt:wt), 
  • high-fat (34% fat, wt:/wt)/low-salt, or 
  • high-fat/high-salt.  
Ad libitum intake (primary outcome) and eating rate, pleasantness, and subjective ratings of hunger and fullness (secondary outcomes) were measured.

The results indicate that salt increased food (= food weight) intakes by 11%, independent of fat concentration (P = 0.022), while increasing the fat intake had no independent effect of fat on food intake (P = 0.6 for the amount of food, not its energy content).
Figure 2: This is what really counts, the effects of modfiying fat and salt content of the meals on total energy intake during the meals; data in kcal per meal (Bolhuis. 2016).
A slightly different picture emerges for the total energy intake, though. Here, the salt intake still mattered (significant with high vs. low salt meals), the main determinant of the total energy intake, however, was the fat content of the meal, with the high-fat meals triggering a whopping +60% (P < 0.001) increase in energy intake in the average subject.

Figure 3: When the diet was high in salt, the mediating effect of fat taste sensitivity on food intake (in g) is lost (Bolhuis. 2016)
Unlike the amount of fat in the meals, the sex of the participants had an effect on the food intake (P = 0.006), with women consuming 15% less by weight of the high-fat meals than the low-fat meals.

More importantly, however, the fat taste sensitivity appeared to decrease signifi-cantly with increasing amounts of salt in the high-fat meals (fat taste x salt interaction on delta intake of high-fat - low-fat meals; P = 0.012), which tended to trigger a satiety effect in the fat sensitive subjects only if they were also low in salt (see Figure 3).
The Overfeeding Overview: High Fat, Carb, Protein, MCTs, Leptin, Testosterone, T3 & Reverse T3 - Get an Overview of the Consequences of Short- & Long-Term Overfeeding - Yes, the existing research shows that high fat intakes (in the presence of carbo-hydrates) are the most fattening.
Bottom line: As the authors of this intriguing study rightly point out, their results "suggest that salt promotes passive overconsumption of energy in adults" (Bolhuis. 2016) and as if that was not bad enough, even those who are sensitive to a higher fat content of food will be fooled into overeating when the high salt content of said foods overrides the fat-mediated satiation.

Ah,... before you rejoice and start eating tons of unsaltet potato chips - there's one thing I should remind you of: even though an excessive increase in dietary fat (from 0.6 to 15.5 g/100g) did not have a main effect on food intake by weight, it led to a 60% higher energy intake, irrespective of the salt content of the meal - an observation that should remind you of the "volume hypothesis" of satiety | Comment!
References:
  • Bolhuis, Dieuwerke P. et al. "Salt Promotes Passive Overconsumption of Dietary Fat in Humans." The Journal of Nutrition (2016): Ahead of print.
  • Hoch, Tobias, et al. "Fat/carbohydrate ratio but not energy density determines snack food intake and activates brain reward areas." Scientific reports 5 (2015).