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Multidisciplinary Approach to Obesity Management: A Case Report
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The role of dairy foods in weight management
1The University of Tennessee, 1215 W. Cumberland Ave, Room 229, Knoxville, TN 37996-1920, USA. mzemel@utk.edu
Abstract:
Dietary calcium appears to play a pivotal role in the regulation of energy metabolism and obesity risk. High calcium diets attenuate body fat accumulation and weight gain during periods of over-consumption of an energy-dense diet and to increase fat breakdown and preserve metabolism during caloric restriction, thereby markedly accelerating weight and fat loss. This effect is mediated primarily by circulating calcitriol, which regulates adipocyte intracellular Ca(2+). Studies of human adipocyte metabolism demonstrate a key role for intracellular Ca(2+) in regulating lipid metabolism and triglyceride storage, with increased intracellular Ca(2+) resulting in stimulation of lipogenic gene expression and lipogenesis and suppression of lipolysis, resulting in adipocyte lipid filling and increased adiposity. Moreover, the increased calcitriol produced in response to low calcium diets stimulates adipocyte Ca(2+) influx and, consequently, promotes adiposity, while higher calcium diets inhibit lipogenesis, promote lipolysis, lipid oxidation and thermogenesis and inhibit diet-induced obesity in mice. Notably, dairy sources of calcium exert markedly greater effects in attenuating weight and fat gain and accelerating fat loss. This augmented effect of dairy products versus supplemental calcium has been localized, in part, to the whey fraction of dairy and is likely due to additional bioactive compounds, such as angiotensin converting enzyme (ACE) inhibitors in dairy, as well as the rich concentration of branched chain amino acids, which act synergistically with calcium to attenuate adiposity; however, these compounds do not fully account for the observed effects, as whey has significantly greater bioactivity than found in these compounds. These concepts are confirmed by epidemiological data as well as recent clinical trials which demonstrate that diets which include at least three daily servings of dairy products result in significant reductions in body fat mass in obese humans in the absence of caloric restriction and markedly accelerates the weight and body fat loss secondary to caloric restriction compared to low dairy diets. These data indicate an important role for dairy products in both the ability to maintain a healthy weight and the management of overweight and obesity.
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