05/04/16'

Biomedical and Sports

Nutrition'

Setanta College | MSc in Strength and Conditioning'

Nutri-on'and'Medical'
Condi-ons'

Content&

!  Vegans'
'
!  Obesity'

!  Female'Athlete'Triad'
'
!  Vitamins'and'Minerals'

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Vegetarian'C'Reasons'

Religious'beliefs ' ' 'Environment'

Economics ' ' ' 'Health'
Ethics'
Poli-cs'
'
hJp://www.ausport.gov.au/ais/nutri-on/factsheets/special_diets/vegetarian_ea-ng'
'

Vegetarianism'C'Types'

Effects'of'vegetarian'diets'on'exercise'performance'
Few'studies'have'examined'link'between'vegetarian'diets'in'well'trained'athletes.'
'
In'theory,'if'a'vegetarian'diet'was'high'in'CHO'and'met'or'exceeded'recommenda-ons'for'other'
macroCnutrients,'micronutrients'and'energy,'then'it'should'match'the'ideal'or'recommended'diet'
for'training'and'recovery.'
'
The'few'studies'that'have'been'conducted'have'shown'no'performance'benefits'over'a'typical'
western'diet'(omnivorous).'
'
Very'difficult'to'conduct'studies'on'topClevel'vegetarian'athletes'–'there'are'too'few'of'them!'
'
Survey'of'over'9000'American'runners'in'1997'C'8%'female'and'3%'males'were'vegetarian'

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Nutrient'Deficiencies'
The'more'restric-ve'the'diet'(restric-on'of'meat,'fish,'dairy),'the'greater'the'risk'of'
nutri-onal'deficiencies.'
'
'
'
'

DiPasquale,'M.'(2002).'Nutri-onal'Concerns'of'Vegetarian'Athletes.'Nutri&onal+Applica&ons+in+Exercise+and+Sport.'Pg'118'
'

Diet'related'concerns'for'vegetarian'athletes'C'Energy'

If'very'high'in'fibre'and'bulk,'energy'intake'is'reduced'because'fibre'increases'sa-ety.'
'
Legumes,'whole'grain'cereals,'grains,'soyaCbeans'and'many'vegetables'and'fruit'are'
highCfibre,'low'fat'and'very'filling.'
'
Vegan'–'incorporate'energy'dense'foods'such'as'nuts,'tofu,'vegetable'protein'and'
meat'analogues'helps'to'increase'energy'density.'
'
LactoCvegetarian'–'addi-on'of'cheese,'yoghurt'and'other'dairy'products'increases'
energy'density.'

Protein'
The'ability'of'vegetarian'athletes,'and'par-cularly'vegans'to'meet'suggested'daily'
protein'intake'has'been'ques-oned.'
'
Vegetable/plant'proteins'may'be'limi-ng'in'one'or'more'essen-al'amino'acids'
(EAA).'
'
Provided'daily'protein'intake'is'met,'combining'different'types'of'plant'foods'
(legumes'and'grains'together,'or'legumes'(peas,'beans,'peanuts)'and'nuts/seeds)'
allow'low'levels'of'AA'in'one'food'to'be'complemented'by'high'levels'in'another.'
'
For'vegans,'total'protein'intake'may'need'to'exceed'protein'requirements'to'meet'
AA'requirements.'

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Complementary'Proteins'

Plant'Protein'C'Leucine'

!  May'be'a'minimum'amount'of'leucine'needed'to'trigger'
MPS.'
!  Leucine'powder'may'need'to'be'added'to'foods'to'increase'
leucine'content.'
'
Food& Qty/100g&
' Len-ls' 2'
Almonds' 1.8'
Chickpeas' 1.4'
Chia'seeds' 1.3'

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Iron'Bioavailability'from'Plant'Sources'
Bioavailability'of'iron'from'plant'foods'is'much'lower'then'in'a'meat'based'diet.'
Naturally'occurring'inhibitors'in'plants'that'bind'iron'from'plant'sources'(nonC
heme'iron)'in'the'gut'and'reduce'iron.'
The'absence'of'meat,'an'enhancer'of'iron'absorp-on'from'plant'sources,'further'
reduces'iron'bioavailability.'
HemeCiron'(meat)'–'more'efficiently'absorbed'than'nonCheme.'

Hunt,'J.'R.'(2003).'Bioavailability'of'iron,'zinc,'and''
other'trace'minerals'from'vegetarian'diets.'T+
he+American+journal+of+clinical+nutri&on,'78(3),'633SC639S.'

Iron'and'Endurance'Athletes'
'
Endurance'runners'have'increased'intes-nal'blood'loss'(exercised'
induced'haemolysis).'
'
Vegetarian'endurance'runners'should'be'regularly'tested'for'
anaemia'(low'iron'levels)'due'to'the'poten-al'for'increased'losses'
and'reduced'absorp-on'rates.'
'
Be'careful'with'supplementa-on'–'increased'risk'of'
hemochromatosis.'Increased'iron'builds'up'in'the'bodies'organs,'
leading'to'damage'(arthiri-s,'heart'disease,'liver'disease).'
'
'

Calcium'
Calcium'intake'in'vegetarians'is'ogen'lower'in'vegetarians'because'of'avoidance'of'dairy'products.'
'
Vegetarians'who'avoid'dairy'products'should'increase'intake'of'green'leafy'vegetables'as'well'as'
calcium'for-fied'foods.'
'
Calcium'bioavailability'from'certain'vegetable'products'is'lower'than'from'dairy'sources'because'of'
absorp-on'inhibitors'(phytates).'
'
Other'inhibitors'(oxalates'found'in'spinach'and'rhubarb)'are'found'in'calcium'rich'foods'so'they'
provide'negligible'absorbable'calcium.'
'
LowCoxalate'vegetables'(kale,'broccoli,'bok'choy)'are'alterna-ve'rich'sources'of'calcium.'
'
Insoluble'dietary'fibre'can'also'inhibit'calcium'absorp-on.'

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260mg'
30mg'

Calcium'Foods'

60mg' 30mgs'

100mgs' 825mgs'

Vitamin'B12'
'
No'ac-ve'vitamin'B12'is'naturally'found'in'any'plant'foods.'
'
Strict'vegetarian'are'at'increased'risk'of'developing'B12'
deficiency.'
'
These'groups'must'consume'foods'for-fied'with'vitamin'B12.'
'
Dairy'products'and'eggs'supply'sufficient'for'B12'lactoCovoC
vegetarians.'
'
'
'

Zinc&
Found'in'red'and'white'meat'and'fish.'
'
Cereal'grains,'legumes,'nuts,'soy'products.'
'
Lower'zinc'intake'have'been'found'in'vegetarians'compared'to'nonCvegetarians.'
'
Phytates,'oxalates,'tannins,'insoluble'fibre'C>'inhibit'zinc'absorp-on.'
'

Riboflavin&
'
Riboflavin'C>'main'source'milk'and'milk'sources,'also'soy'milk'

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Phytates'
Storage'form'of'phosphorus'in'many'plant'-ssues.'
'
Found'in'the'hulls'of'nuts,'seeds'and'grains.'
'
Inhibits'the'absorp-on'of'many'minerals'in'the'intes-ne.'
'
Processes'such'as'soaking'and'sprou-ng'of'nuts'and'seeds'
reduces'phytate'content'of'food'and'thus'increase'mineral'
absorp-on'in'the'intes-ne.''

Vegetarians'and'Crea-ne'

As'discussed'last'week,'vegetarians'may'have'low'muscle'
crea-ne'content'due'to'reduced'dietary'crea-ne.'
'
Vegetarian'athletes,'especially'strength'and'power'athletes'may'
benefit'from'crea-ne'supplementa-on.'

Female'Athlete'Triad'
Amenorrhea'C'Women'who'have'missed'at'least'three'menstrual''
periods'in'a'row'have'amenorrhea,'as'do'girls'who'haven't'begun''
menstrua-on'by'age'15''
'
Energy'Availability'–the'amount'of'dietary'energy'remaining''
ager'exercise'training'for'all'other'metabolic'processes.'

Female'AT'is'a'detrimental'consequence'of'the'failure'to'ingest'adequate'energy''
to'compensate'for'energy'expended'during'exercise.''

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Female'AT'–'Reasons'for'development'

1.  Inten-onal'–'modifying'body'size'and'compe--on'to'achieve'appearance'or'
performance'goals.'

2.  Compulsive'–'demonstra-ng'disordered'ea-ng'and/or'pathological'weight'control'
behaviour'

3.  Inadvertent'–'failing'to'match'energy'intake'to'exercise'induced'energy'
expenditure.'

Results'in'energy'deficiency,'which'when'sustained'for'long'periods'of'-me,'
translates'into'metabolic'and'reproduc-ve'suppression.'

Female'AT'C'prevalence'
MetaCanalysis'of'65'studies'(n=10,500)'
Prevalence'of'all'three'symptoms'–'range'from'0'–'16%'
Prevalence'of'two'symptoms'–'range'from'3'–'27%'
Prevalence'of'at'least'one'symptom'–'16'–'60%'
'
Prevalence'of'low'BMD'is'lower'in'comparison'with'es-mates'of'menstrual'dysfunc-on'or'ea-ng'disorders'(ED).'
'
Problem'with'determining'if'low'Energy'Availability'(EA)'is'prevalent'due'to'methodological'errors'in'determining'energy'
expenditure'and'energy'intake.'
'
Female'AT'related'condi-ons'predominate'in'lean'sports'(gymnas-cs,'figure'ska-ng,'ballet,'diving,'swimming,'long'distance'

'
running).'These'types'of'athletes'are'suggested'to'be'at'greater'risk'of'demonstra-ng'low'EA'and'or'DE'based'on'the'high'
prevalence'of'energy'restric-on'and/or'die-ng'behaviours'reported'in'these'athletes.
'
Gibbs,'J.'C.,'Williams,'N.'I.,'&'De'Souza,'M.'J.'(2013).'Prevalence'of'individual'and'combined'components'of'the'female'athlete'triad.'Medicine+and+science+in+sports+
and+exercise,'45(5),'985C996.'

'

Rela-ve'Energy'Deficiency'in'Sports'(REDCS)'

Impaired'physiological'func-on,'including'but'not'limited'to:'
!  Metabolic'Rate'
!  Menstrual'dysfunc-on'
!  Bone'health'
!  Immunity'
!  Protein'synthesis'
!  Cardiovascular'health'

Inadequacy'of'energy'to'support'the'range'of'body'func-ons'involved'in'op-mal'health'and'
performance.'
'
Mountjoy,'M.,'SundgotCBorgen,'J.,'Burke,'L.,'Carter,'S.,'Constan-ni,'N.,'Lebrun,'C.,'...'&'Ljungqvist,'A.'(2014).'The'IOC'consensus'statement:'beyond'
the'Female'Athlete'Triad—Rela-ve'Energy'Deficiency'in'Sport'(REDCS).'Bri&sh+journal+of+sports+medicine,'48(7),'491C497.'

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Effects'of'REDCS'
''''''''''''''''Affects&both&men&and&women&
'Detec>ng&RED@S&
' &
Alters'levels'of'hormone'and'metabolic'substrates'including:' •  Presenta-on'of'ea-ng'
!  Luteinsing'Hormone' disorder'or'disordered'ea-ng.'
!  IGFC1' •  Weight'loss'
Ghrelin'
! 
•  Lack'of'normal'growth'and'
Lep-n'
development'
! 

!  Glucose'
!  FaJy'Acids' •  Menstrual'dysfunc-on'
!  Ketones' •  Recurrent'illnesses'and'
injuries'
!  Nutrient'deficiencies' •  Decreased'performance'
Psychological'distress'
! 
•  Mood'changes'
Unfavourable'lipid'profiles'
No'best'screening'tool/
! 

!  Reduced'muscle'protein'synthesis'
ques-onnaire'

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Treatment'of'REDCS'
'
Increase'in'energy'intake,'decrease'in'energy'expenditure'or'both.'
'
In'collegiate'athletes,'weight'gain'is'the'strongest'predictor'of'normal'menstrual'func-on.'
'
Contracep-on'may'mask'low'EA,'menstrual'dysfunc-on'and'perpetuate'bone'loss.'
'
BMD'–'mechanical'loading'(RT,'plyometrics),'calcium'and'vitamin'D'supplementa-on.'
'
If'athlete'cannot'follow'rehabilita-on'plan'then'psychological'factor'may'be'the'cause.'

Glucose'Uptake'–'GLUT4'
Insulin'causes'GLUT4'transloca-on'to'muscle'surface'allowing'glucose'
absorp-on.'
'
However,'exercise'also'causes'GLUT4'transloca-on,'independent'of'
ac-on'of'insulin.'
'
If'you'can’t'produce'insulin'(type'I),'or'are'insulin'resistant,'then'
exercises'provides'a'means'of'getng'glucose'into'muscle.'
'
Goodyear,'PhD,'L.'J.,'&'Kahn,'MD,'B.'B.'(1998).'Exercise,'glucose'transport,'and'insulin'sensi-vity.'Annual+review+of+medicine,'49(1),'235C261.'

Obesity'
Overweight'and'obesity'are'defined'as'abnormal'or'excessive'fat'accumula-on'that'presents'a'risk'to'health'(WHO).''
'
'

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Obesity'–'prevalence'(WHO)'
!  Worldwide'obesity'has'more'than'doubled'since'1980.'

!  In'2014,'more'than'1.9'billion'adults,'18'years'and'older,'were'overweight.'Of'these'over'600'million'were'
obese.'

!  39%'of'adults'aged'18'years'and'over'were'overweight'in'2014,'and'13%'were'obese.'
'
!  Most'of'the'world's'popula-on'live'in'countries'where'overweight'and'obesity'kills'more'people'than'
underweight.'

!  42'million'children'under'the'age'of'5'were'overweight'or'obese'in'2013.'

!  Obesity'is'preventable.'

!  hJp://www.who.int/mediacentre/factsheets/fs311/en/'

'

Obesity'–'Prevalence'in'Ireland'
A'review'of'published'studies'(14)'in'Ireland'(2002C12)'show'that'the'prevalence'of'obesity'in'
Ireland'amongst'primary'school'children'ranges'from'20C34%.'
'
Slight'↓in'obesity'and'morbid'obesity'in'this'-me'period'
Indicates'that'obesity'may'be'plateauing'in'this'age'group.'
'
An'individual'is'considered'morbidly'obese'if'he'or'she'is'100'pounds'over'his/her'ideal'body'
weight,'has'a'BMI'of'40'or'more,'or'35'or'more'and'experiencing'obesityCrelated'health'
condi-ons,'such'as'high'blood'pressure'or'diabetes.'
'
Keane,'E.,'Kearney,'P.'M.,'Perry,'I.'J.,'Kelleher,'C.'C.,'&'Harrington,'J.'M.'(2014).'Trends'and'prevalence'of'overweight'and'obesity'in'primary'school'aged'children'in'the'
Republic'of'Ireland'from'2002C2012:'a'systema-c'review.BMC+public+health,'14(1),'974.'

'
'

Obesity'–'Prevalence'in'Ireland'
Compared'changes'in'BMI'and'other'markers'over'20'years.'
Significant'↑'in'mean'weight,'height'and'BMI.'
Significant'↑'in'waist'and'hip'circumferences'and'waist'to'hip'ra-o.'
'
'
'
'
'
'
'
'
'
'
'
'
'
Boylan,'E.'A.,'McNulty,'B.'A.,'Walton,'J.,'Flynn,'A.,'Nugent,'A.'P.,'&'Gibney,'M.'J.'(2014).'The'prevalence'and'trends'in'overweight'and'obesity'in'Irish'
adults'between'1990'and'2011.'Public+health+nutri&on,'17(11),'2389C2397.'

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Metabolic'Syndrome'
Metabolic'syndrome'is'the'name'for'a'group'of'risk'factors'that'raises'your'risk'for'heart'disease'and'other'health'problems,'such'
as'diabetes'and'stroke.'
'
Metabolic&Risk&Factors&
The'five'condi-ons'described'below'are'metabolic'risk'factors.'You'can'have'any'one'of'these'risk'factors'by'itself,'but'they'tend'to'
occur'together.'You'must'have'at'least'three'metabolic'risk'factors'to'be'diagnosed'with'metabolic'syndrome.'
'
!  A'large'waistline.'This'also'is'called'abdominal'obesity'or'"having'an'apple'shape."'Excess'fat'in'the'stomach'area'is'a'greater'risk'
factor'for'heart'disease'than'excess'fat'in'other'parts'of'the'body,'such'as'on'the'hips.'
!  A'high'triglyceride'level'(or'you're'on'medicine'to'treat'high'triglycerides).'Triglycerides'are'a'type'of'fat'found'in'the'blood.'
!  A'low'HDL'cholesterol'level'(or'you're'on'medicine'to'treat'low'HDL'cholesterol).'HDL'some-mes'is'called'"good"'cholesterol.'This'
is'because'it'helps'remove'cholesterol'from'your'arteries.'A'low'HDL'cholesterol'level'raises'your'risk'for'heart'disease.'
!  High'blood'pressure'(or'you're'on'medicine'to'treat'high'blood'pressure).'Blood'pressure'is'the'force'of'blood'pushing'against'the'
walls'of'your'arteries'as'your'heart'pumps'blood.'If'this'pressure'rises'and'stays'high'over'-me,'it'can'damage'your'heart'and'lead'
to'plaque'buildup.'
!  High'fas-ng'blood'sugar'(or'you're'on'medicine'to'treat'high'blood'sugar).'Mildly'high'blood'sugar'may'be'an'early'sign'of'
diabetes.'
!  hJp://www.nhlbi.nih.gov/health/healthCtopics/topics/ms'

'

What'causes'obesity?'
'
GluJony'and'sloth'–'people'eat'too'much'and'are'lazy ' ' ''Stress'and'sleep'
levels'
'
Sedentary'jobs ' ' ' ' ' '''Processed'food'
'
Food'availability'–'food'is'everywhere'and'generally'cheap ' 'Transport'(drive'everywhere)'
'
Food'por-on'sizes'(USA) ' ' ' ' 'Entertainment'(TV'and'games'
consoles)'
'
Obesogenic'environment'–'chemicals'in'packaging'and'sprays ' ''''Mental'illness'or'trauma-c'
experience'(i.e.' ' ' ' ' ' ' '
'physical'or'sexual'abuse)'
'
'
'

Health'Time'Bomb'C'Adults''
'''''''''''''''''''''''''''''' ' '''
Irish'Independent,'6th'May'2015,p7)'

!  85%'of'women'will'be'overweight'&'57%'obese'by'2030.'
!  89%'of'men'will'be'overweight'&'48%'obese'by'2030.'
!  Ireland'to'be'on'course'as'the'most'obese'country'in'Europe'
in'15'years'-me.'
!  Reason'–'por-on'sizes,'rich'foods,'alcohol'consump-on'
combined'with'lack'of'exercise.''
!  Poten-al'of'following'US'with'children'being'born'with'
diabetes.''

'

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Childhood'Obesity'
!  Obesity'at'childhood'is'associated'with'health'risks'–'elevated'blood'
pressure'or'blood'cholesterol,'type'2'diabetes,'breathing'issues.'
'
!  Knock'on'effects'in'adolescent'and'adult'life'in'psychological'areas'–'
poor'self'image,'low'self'confidence'and'self'esteem.'
'
!  This'is'due'to'lack'of'physical'exercise'and'unhealthy'diet''
' ' ''''(Irish'Independent,'7'June'2014)'

Food'
Pyramid'
1977'

US'MyPlate'

hJps://
cdn1.sph.harvard.
edu/wpCcontent/
uploads/sites/
30/2013/04/
HEPApr2013.jpg'
'

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Fat'and'CVD'
Systema-c'review'of'evidence'linking'food'intake'and'CVD.'
'
No'associa-on'between'saturated'and'polyunsaturated'fat,'
total'fat,'meat,'eggs'and'milk'on'CVD.'
'
Harmful'C>'transCfats'and'high'GI'foods.'
'
'
Mente,'A.,'de'Koning,'L.,'Shannon,'H.'S.,'&'Anand,'S.'S.'(2009).'A'systema-c'review'of'the'evidence'suppor-ng'a'causal'link'between'dietary'factors'
and'coronary'heart'disease.'Archives+of+internal+medicine,'169(7),'659C669.'

Gary'Taubes'–'Good'Calories/Bad'Calories'
Obesity'is'caused'by'excessive'carbohydrate'(and'especially'refined'carbohydrates)'consump-on.'
'
Chronically'elevated'insulin'levels'(hyperinsulinemia)C>'Promotes'fat'storage'and'inhibits'fat'
release'from'adipose'-ssue.'
'
State'of'chronic'malnutri-on!!'
'
Even'though'ea-ng'lots'of'food,'excessive'storage'in'adipose'-ssue'means'that'there'is'liJle'energy'
available'for'the'body.''
'
Because'of'excessive'energy'storage,'energy'available'for'physical'ac-vity'is'reduced.'
'
GluJony'and'sloth!!'

Lep-n'&'Ghrelin'
Lep>n'C>'suppresses'appe-te'(sa-ety'hormone).'Made'by'fat'cells.'
Secreted'when'fat'cells'are'full.'Acts'on'hypothalamus'and'also'on'peripheral'
-ssues.'Reduces'the'sensa-on'of'hunger'and'increases'energy'expenditure.'
'
Ghrelin'C>'s-mulates'hunger'(hunger'hormone).'Secreted'in'GI'tract.'When'
stomach'is'empty,'ghrelin'is'secreted.'When'stomach'is'stretched'(full),'
ghrelin'secre-on'is'stopped.'Acts'on'hypothalamus.''

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Lep-n'Resistance'

Lep-n'Resistance'
Behavioural'manifesta-ons'C>'excessive'intake'of'energy'dense'or'highly'palatable'
foods'
'
Impaired'reduc-on'in'food'consump-on'and'body'weight'in'response'to'central'or'
peripheral'administra-on'of'lep-n.'
'
Blood'Brain'Barrier'C>'becomes'saturated'at'rela-vely'low'levels'of'circula-ng'lep-n.'
'
Altera-ons'in'lep-n'receptor'expression'in'hypothalmus'which'act'to'inhibit'lep-ns'
normal'feeding'and'body'weight'regula-on'signals.'
'
Feeding'rats'a'high'fat'diet'results'in'lep-n'resistance'in'3C5'days.'
'
Vasselli,'J.'R.,'Scarpace,'P.'J.,'Harris,'R.'B.,'&'Banks,'W.'A.'(2013).'Dietary'components'in'the'development'of'lep-n'resistance.'Advances+in+Nutri&on:+An+Interna&onal+Review+Journal,'4(2),'
164C175.'

Why'Diets'Don’t'Work'
While'lowCcalorie'die-ng'may'work'in'the'shortCterm,'in'the'long'term,'
the'brain'will'sense'“starva-on”'mode'and'ini-ate'feeding'signals.'
'
Most'people'who'diet'will'experience'weight'regain'above'what'they'
were'when'they'ini-ally'started'the'diet'C>'adap-ve'thermogenesis!!'
'
Body'also'becomes'more'efficient'at'using'less'calories.'When'normal'
calorie'intake'is'resumed,'body'needs'less'calories.'
'
Will'power'cannot'over'power'the'hypothalamus!'

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High'Protein'Diets'
High'protein'diets'appear'to'be'a'sustainable'way'of'reducing'excess'body'fat.'
'
Sa-a-ng'effect'of'protein'C>'protein'intake'results'in'the'release'of'anorexigenic'gut'hormones'
(suppress'appe-te)'
'
Thermic'Effect'of'Food'
'
WesterterpCPlantenga,'M.'S.,'Nieuwenhuizen,'A.,'Tome,'D.,'Soenen,'S.,'&'Westerterp,'K.'R.'(2009).'
Dietary'protein,'weight'loss,'and'weight'maintenance.Annual+review+of+nutri&on,'29,'21C41.'

16'