What type of foods can burn fat ?

Foods that can burn more calories (fat)

It’s true: Certain foods have a very high thermogenic effect, so you literally burn calories as you chew. Other foods contain nutrients and compounds that can increase your metabolic rate.

Theoretically, based on the amount of ATP (adenosine triphosphate is the energy currency of life or a source of energy found in every cell, ATP main role is to store and supply the cell with needed energy for physiological reactions) required for the initial steps of metabolism and storage, the thermic effect of food (TEF) is different for each nutrient ¹. Reported thermic effect of food values for separate nutrients ², ³ are:

• Fat ~ 0 to 3%
• Carbohydrate ~ 5 to 10%
• Protein 20 to 30%
• Alcohol ~ 10 to 30%.

The main effect of protein on energy balance is thought to be thermic effect of food (TEF) related satiety. Satiety scores were higher during meals with a high-protein/high-carbohydrate diet, as well as over 24 h, than with a high-fat diet ⁴. The observed thermic effect of food related satiety might be ascribed to the high protein rather than the high carbohydrate content of the diet. Postprandial thermogenesis was increased 100% on a high-protein/low-fat diet versus a high-carbohydrate/low-fat diet in healthy subjects ⁵. The thermic effect of food increases body temperature, which may be translated into satiety feelings. High-protein diets are favored for weight maintenance, also after weight loss, by favoring maintenance or regain of fat-free mass, by reducing the energy efficiency through a higher thermogenesis, and by reducing intake through an increased satiety ⁶.

In this study ⁷, Schwartz et al. evaluated the thermic response to both a high carbohydrate meal and a high fat meal in normal and obese subjects. The metabolic rate was measured in seated subjects before and for 6 hours following a meal. Blood samples for insulin, glucose, and catecholamines were withdrawn each half hour to evaluate their possible role in regulating the thermic response. The overall response to the high carbohydrate meal was greater than to high fat. The thermic response to the high fat meal, however, was similar in the normal and obese groups. Although the 6-hour response to the high carbohydrate diet was not statistically different between the subject groups, there was a trend toward a diminished response in the obese relative to the normal group during the first 3 hours following the meal. In the seated subjects, the thermic response to a meal accounted for 8%-13% of the total calories ingested, with the highest value found in the normal weight subjects after a high carbohydrate meal ⁷.

In healthy subjects with a mixed diet, the thermic effect of food (TEF) represents about 10% of the total amount of energy ingested over 24 h. When a subject is in energy balance, where intake equals expenditure, the thermic effect of food (TEF) is 10% of daily energy expenditure ⁸.

You’ve probably heard people blame their weight on a slow metabolism, but what does that mean ? Is metabolism really the culprit ? And if so, is it possible to rev up your metabolism to burn more calories ?

It’s true that metabolism is linked to weight. But contrary to common belief, a slow metabolism is rarely the cause of excess weight gain. Although your metabolism influences your body’s basic energy needs, it’s your food and beverage intake and your physical activity that ultimately determine how much you weigh.

In this study comparing the thermic effect of food responsiveness in habitually exercising and sedentary healthy adult humans found greater TEF in habitual exercisers than sedentary healthy adult humans ⁹.

Metabolism: Converting food into energy

Metabolism is the process by which your body converts what you eat and drink into energy. During this complex biochemical process, calories in food and beverages are combined with oxygen to release the energy your body needs to function. A diet induced energy expenditure only accounts for 8 to 15 % of your daily energy expenditure (see Table 1 below). The most important components of the daily energy expenditure are your basal metabolic rate (resting energy expenditure) which consumes 60-70% of your total energy expenditure and your exercise (ExEE) and non-exercise energy expenditure (NEAT).

Even when you’re at rest, your body needs energy for all its “hidden” functions, such as breathing, circulating blood, adjusting hormone levels, and growing and repairing cells.

The number of calories your body uses to carry out these basic functions is known as your basal metabolic rate — what you might call metabolism. Several factors determine your individual basal metabolic rate, including:

• Your body size and composition. The bodies of people who are larger or have more muscle burn more calories, even at rest.
• Your sex. Men usually have less body fat and more muscle than do women of the same age and weight, burning more calories.
• Your age. As you get older, the amount of muscle tends to decrease and fat accounts for more of your weight, slowing down calorie burning.

Energy needs for your body’s basic functions stay fairly consistent and aren’t easily changed. Your basal metabolic rate accounts for about 70 percent of the calories you burn every day.

In addition to your basal metabolic rate, two other factors determine how many calories your body burns each day:

• Food processing (food induced thermogenesis or thermic effect of food (TEF)). Digesting, absorbing, transporting and storing the food you consume also takes calories. This accounts for 100 to 800 of the calories used each day. For the most part, your body’s energy requirement to process food stays relatively steady and isn’t easily changed.

• Physical activity. Physical activity and exercise — such as playing tennis, walking to the store, chasing after the dog and any other movement — account for the rest of the calories your body burns up each day. Physical activity is by far the most variable of the factors that determine how many calories you burn each day. The thermic effects of food and exercise were studied on groups of 10 normal weighted and 14 obese subjects using oxygen consumption as the criterion of energy expenditure. The results indicated that the increased resting metabolism resulting from the ingestion of a 4.200 kJ (1003 kCal) mixed content meal was similar in the two groups (12–17%). But the further potentiation of this thermic effect resulting from exercise following a meal was virtually absent in the obese group (0.8%), while in the normally weighted controls it amounted to a further 17% ¹¹.

• Exercise. During exercise, contracting skeletal muscles release the hormone irisin into circulation. Irisin can induce energy-storing white fat cells to take on characteristics of brown fat (or adipose) cells, which burn energy by generating heat. This muscle-fat crosstalk has intrigued scientists because it’s unclear why muscle tissue, which generates heat when active, would also stimulate fat cells to produce heat. A popular idea is that a major benefit of physical activity comes not only from the actual energy that is expended during the exercise itself but also from an after-effect of physical activity on resting energy expenditure ¹², ¹¹. There are data showing a positive effect of vigorous or moderate physical activity on resting energy expenditure. This follows 2 separate phases: a large effect that lasts ∼ 2 h and a smaller but more prolonged effect that could take up to 48 h to return to baseline ¹³. This is called excess post-exercise oxygen consumption and accounts for ∼ 6–15% of the energy expended during an exercise session ¹⁴. These findings from non-obese male subjects suggest that individuals with a high VO2 max (such as aerobically trained athletes) show a greater the thermic effect of food (TEF) after eating, particularly after a large meal, than do individuals with a low VO2 max ¹⁵. In another study involving 10 healthy women who were given a 10 week graded exercise program of jogging. Pretraining thermic effect of food (TEF) was a linear function of VO2max. Following exercise training, the women showed a significant increase (20%) in VO2max and loss (10.4%) of body fat; body weight did not change. Fat loss was directly related to changes in VO2max and resting energy expenditure ¹⁶.

• Build Muscle Mass. The most efficient way to raise your metabolism is to increase and maintain muscle, which can most effectively be accomplished through correct muscular (resistance) training. Lifting weights raises your metabolism long after you’re finished—experts estimate that your metabolism stays elevated for up to 39 hours! Again, this is because lifting strains your body so much, that it needs extra time to recover. The more active your muscles are and the more you “break them down” during muscular training, the more energy your body needs for metabolism and repair; and most of that low intensity energy is from fat.
• In a small study on the thermic effect of food and exercise in lean and obese men of similar lean body mass ¹⁷. Segal and colleagues put eight lean and eight obese men to 30 min of cycle exercise over 5 days to determine whether exercise before or after a meal enhances thermogenesis. The groups were matched for age, height, and lean body mass in order to study the relationship between thermogenesis and body fat independent of lean body mass. Treatments on respective days were Day 1) 3 hour rest, no meal; Day 2) 3 hour rest after a 750-kcal mixed meal (14% protein, 31% fat, 55% carbohydrate); Day 3) during and 3 h after 30 min of cycling, no meal; Day 4) during and 3 h after 30 min of cycling, meal 30 min before exercise; and Day 5) 3 h after 30 min of cycling, meal immediately after exercise. The thermic effect of food, was significantly greater for the lean than the obese men under the resting state, exercise and both post-exercise conditions. However, for the lean men the thermic effect of food was significantly greater for the meal-before-exercise than the resting and the meal-after-exercise conditions ¹⁷.

• Compared to women, men’s bodies generally have more muscle and less fat which makes a difference to your BMR. While fat burns very few kilojoules, muscle is an active, ‘hungry’ tissue that uses up kilojoules even when you’re just sitting around. Your body constantly burns calories, even when you’re doing nothing. Muscle tissue is the most metabolically active tissue in your body, and the breakdown of old protein and synthesis of new protein in your muscles accounts for roughly one-fifth of your resting metabolic rate. This resting metabolic rate is much higher in people with more muscle. Every pound of muscle uses about 6 calories a day just to sustain itself, while each pound of fat burns only 2 calories daily. That small difference can add up over time. As a result, gaining muscle tissue helps you pack more metabolically active lean mass onto your frame, which will increase your calorie burn, even when you’re resting. To do that, you’ll need to get active with strength training. Include two or three strength training workouts that work every major muscle group in your body. As a bonus, strength training helps prevent or offset muscle loss as you age, so you’ll keep you basal metabolism higher for longer. After a session of strength training, muscles are activated all over your body, raising your average daily metabolic rate.

Total Daily Energy Expenditure

Your total daily energy expenditure (TEE) consists of four components:

1. Basal Metabolic Rate (resting energy expenditure or REE),
2. Diet-Induced Thermogenesis (thermic effect of food or TEF)
3. Energy Cost of Physical Activity (exercise energy expenditure or ExEE) and
4. Non-exercise Activity of Thermogenesis (NEAT) i.e. fidgeting, maintenance of posture and other physical activities of daily life.

Figure 1.  Model of human energy expenditure compartments ¹⁸. Exercise related activity (e.g. jogging, walking, cycling, weight lifting) is exercise energy expenditure (ExEE), while spontaneous physical activity relates to nonexercise activity thermogenesis (NEAT) (e.g. maintenance of posture and other physical activities of daily life). Note that parts of spontaneous physical activity are beyond voluntary control, i.e. “fidgeting”.

Influences on Basal Metabolic Rate

Your basal metabolic rate is influenced by multiple factors working in combination, including:

• Body size – larger adult bodies have more metabolising tissue and a larger BMR
• Amount of lean muscle tissue – muscle burns kilojoules rapidly
• Amount of body fat – fat cells are ‘sluggish’ and burn far fewer kilojoules than most other tissues and organs of the body
• Crash dieting, fad diets – eating too few kilojoules encourages the body to slow the metabolism to conserve energy. BMR can drop by up to 15 per cent. Loss of lean muscle tissue further reduces BMR
• Age – metabolism slows with age due to loss of muscle tissue, but also due to hormonal and neurological changes
• Growth – infants and children have higher energy demands per unit of body weight due to the energy demands of growth and the extra energy needed to maintain their body temperature
• Gender – generally, men have faster metabolisms than women because they tend to be larger
• Genetic predisposition – your metabolic rate may be partly decided by your genes
• Hormonal and nervous controls – BMR is controlled by the nervous and hormonal systems. Hormonal imbalances can influence how quickly or slowly the body burns kilojoules
• Environmental temperature – if temperature is very low or very high, the body has to work harder to maintain its normal body temperature, which increases the BMR
• Infection or illness – BMR increases because the body has to work harder to build new tissues and to create an immune response
• Amount of physical activity – hard-working muscles need plenty of energy to burn. Regular exercise increases muscle mass and teaches the body to burn kilojoules at a faster rate, even when at rest
• Drugs – some drugs, like caffeine or nicotine, can increase the BMR
• Dietary deficiencies – for example, a diet low in iodine reduces thyroid function and slows the metabolism.

Boosting metabolism is believed by some people to be the holy grail of weight loss. However, trying to boost your metabolism probably won’t lead to weight loss, at least not to the degree that changing your diet and lifestyle habits will. Only rarely is excessive weight gain caused by a medical problem that slows metabolism, such as Cushing’s syndrome or an underactive thyroid gland (hypothyroidism).

Thermic Effect of Food

The thermic effect of food (TEF), also called diet-induced thermogenesis, is the increment of energy expenditure above resting energy expenditure (REE) following meal ingestion and is a relatively stable component (see figure 1). The thermic effect of food lies in a range of 8-15% of your total energy expenditure (TEE) and is related to food digestion, absorption and storage. The variance of thermic effect of food has been associated with nutrient composition and energy content of consumed foods ¹⁹.

Your BMR rises after you eat because you use energy to eat, digest and metabolise the food you have just eaten. The rise occurs soon after you start eating, and peaks two to three hours later. This rise in the BMR can range between two per cent and 30 per cent, depending on the size of the meal and the types of foods eaten. However in a small study on the effect of meal frequency on the thermic effect of food in women who were fed either high carbohydrate-low fat meal and low carbohydrate-high fat meal, showed meal frequency and meal composition did not seem to influence the thermic effect of food ²⁰. And in an another study on meal or feeding frequency and human energy metabolism ²¹. Wilhelmine and colleagues found no significant effect of meal frequency to the contribution of average daily metabolic expenditure (TEE) could be demonstrated ²¹.

Variability in the thermic effect of fat can be attributed to differences in molecular structure that significantly alter its metabolism. For example, Seaton et al. ²² found that medium chain triglycerides (MCTs) produced a significantly greater thermic effect than long chain triglycerides during a 6-hour postprandial period (12 vs. 4% higher than basal oxygen consumption). Differences in the thermic effect of food of protein have also been observed in direct comparisons. Acheson et al. ²³ demonstrated that within mixed-macronutrient meals (50% protein, 40% carb, 10% fat) meals, whey had a higher thermic effect than casein, which had a higher thermic effect than soy protein. All protein sources had a higher thermic effect than an all-carbohydrate meal. Importantly, the thermic effect of each macronutrient can vary within and across individuals ²⁴. In any case, protein has consistently shown a higher thermic effect than carbohydrate or fat. Alcohol has been reported to have a similar thermic effect to protein but with a wider range of 10–30% ²⁵.

A study on effect of meal composition and energy content on the thermic effect of food with sixteen adult, non-obese female subjects, who were given either high-carbohydrate-low-fat and low-carbohydrate-high-fat, the energy contents of the test meals for each composition were 2520 kJ (600 kcal) and 5040 kJ (1200 kcal). The study found that thermic effect of food is significantly influenced by the energy content of a meal but not by meal composition ²⁶.

In a study to find out if weight loss has any effect on the thermic effect of food ²⁷. The thermic effects of food (TEF) were measured before and after weight reduction in moderately overweight adult women. Nine women weighing between 62.1 and 84.7 kg lost an average of 7.3 kg while on a reduced calorie, low fat diet for between 12 and 14 weeks. After weight reduction, the average resting energy expenditure of these subjects decreased by 8.8% or 515 kJ (123 kcal)/day. The researchers found no change in the thermic effects of food after weight reduction ²⁷.

Different foods raise BMR by differing amounts. For example:

• fats raise the BMR 0–5 per cent
• carbohydrates raise the BMR 5–10 per cent
• proteins raise the BMR 20–30 per cent
• hot spicy foods, for example, foods containing chilli, horseradish and mustard can have a significant thermic effect.

Believe us, there are lots of companies out there trying to find something that will help your metabolic rates. For example, caffeine has been shown to very slightly increase metabolism, but it doesn’t appear to have a significant effect on long-term weight loss. Likewise, supplements claiming to boost your metabolism may have little or no benefit and may contain substances that can have serious health effects or may be banned.

How much you weigh you lose really depends on the number of calories you eat and how much physical activity you get. Your energy IN and energy OUT don’t have to balance exactly every day. Most of the energy you expend each day is used to keep all the systems in your body functioning properly. This is out of your control. However, you can make metabolism work for you when you exercise.It’s the balance over time that will help you maintain a healthy weight in the long run. For many people, this balance means  eating fewer calories and increasing their physical activity.

Boosting metabolism is the holy grail of weight watchers everywhere, but how fast your body burns calories depends on several things. Some people inherit a speedy metabolism. Men tend to burn more calories than women, even while resting. Your metabolism changes as you get older and for most people, metabolism slows steadily after age 40. You burn fewer calories and break down foods differently. You also lose lean muscle. Unless you exercise more and adjust your diet, the pounds can add up. Cutting back on calories is a matter of choice and middle-age spread can quickly become middle-age sprawl. Making healthy food choices that are lower in fats, especially saturated and
trans fats, as well as cholesterol, sodium (salt), and added sugar, can help you cut back on calories, as can paying attention to portion size. Although you can’t control your age, gender, or genetics, there are other ways to improve your metabolism.

Metabolism and weight

It may be tempting to blame your metabolism for weight gain. But because metabolism is a natural process, your body has many mechanisms that regulate it to meet your individual needs. Only in rare cases do you get excessive weight gain from a medical problem that slows metabolism, such as Cushing’s syndrome or having an underactive thyroid gland (hypothyroidism).

Unfortunately, weight gain is complicated. It is likely a combination of genetic makeup, hormonal controls, diet composition, and the impact of environment on your lifestyle, including sleep, physical activity and stress. All of these factors result in an imbalance in the energy equation. You gain weight when you eat more calories than you burn — or burn fewer calories than you eat.

While it is true that some people seem to be able to lose weight more quickly and more easily than others, everyone will lose weight when they burn up more calories than they eat. Therefore, to lose weight, you need to create an energy deficit by eating fewer calories or increasing the number of calories you burn through physical activity or both.

A closer look at physical activity and metabolism

While you don’t have much control over the speed of your basal metabolism, you can control how many calories you burn through your level of physical activity. The more active you are, the more calories you burn. In fact, some people who are said to have a fast metabolism are probably just more active — and maybe more fidgety — than are others.

You can burn more calories with:

• Regular aerobic exercise. Aerobic exercise is the most efficient way to burn calories and includes activities such as walking, bicycling and swimming. As a general goal, include at least 30 minutes of physical activity in your daily routine. If you want to lose weight or meet specific fitness goals, you may need to increase the time you spend on physical activity even more. If you can’t set aside time for a longer workout, try 10-minute chunks of activity throughout the day. Remember, the more active you are, the greater the benefits.

• Strength training. Strength training exercises, such as weightlifting, are important because they help counteract muscle loss associated with aging. And since muscle tissue burns more calories than fat tissue does, muscle mass is a key factor in weight loss.

• Lifestyle activities. Any extra movement helps burn calories. Look for ways to walk and move around a few minutes more each day than the day before. Taking the stairs more often and parking farther away at the store are simple ways to burn more calories. Even activities such as gardening, washing your car and housework burn calories and contribute to weight loss.

Don’t look to dietary supplements for help in burning calories or weight loss. Products that claim to speed up your metabolism are often more hype than help and some may cause undesirable or even dangerous side effects. Dietary supplement manufacturers aren’t required by the Food and Drug Administration to prove that their products are safe or effective, so view these products with caution and skepticism, and always let your doctors know about any supplements you take.

There’s no easy way to lose weight. The foundation for weight loss continues to be based on physical activity and diet. Take in fewer calories than you burn, and you lose weight.

Our knowledge is increasing about all of the mechanisms that impact appetite, food selection, and how your body processes and burns food.

Feed your metabolism with these Fat Burning Foods :

• Water. Drinking 500ml of water, over a period of 1 to 1.5 hours, can help boost your metabolism by 24-30%.
• Whole grains. Your body burns twice as many calories breaking down whole foods (especially those rich in fiber such as oatmeal and brown rice) than processed foods.
• Foods high in fiber like fruits & vegetables. A high-fiber diet has many benefits, including normalizing bowel movements, helping maintain bowel integrity and health, lowering blood cholesterol levels, and helping control blood sugar levels. A high-fiber diet may also aid in achieving and maintaining a healthy weight.
• Lean meats and Protein. Protein has a high thermogenic effect: You burn about 30% of the calories the food contains during digestion (so a 300-calorie chicken breast requires about 90 calories to break it down) ²⁸. People also tend to feel fuller, on fewer calories, after eating protein than they do after eating carbohydrate or fat ²⁹. Protein seems to also help people hang on to lean muscle during weight loss, and this, too, can help boost the energy-burned side of the energy balance equation ²⁸.

Higher protein, lower carbohydrate diets improve blood lipid profiles and other metabolic markers, so they may help prevent heart disease and diabetes ³⁰, ³¹, ³². But some high-protein foods are healthier than others: High intakes of red meat and processed meat are associated with an increased risk of heart disease, diabetes, and colon cancer ³³, ³⁴, ³⁵.

Replacing red and processed meat with nuts, beans, fish, or poultry seems to lower the risk of heart disease and diabetes ³³, ³⁵. And this diet strategy may help with weight control, too, according to a recent study from the Harvard School of Public Health. Researchers tracked the diet and lifestyle habits of 120,000 men and women for up to 20 years, looking at how small changes contributed to weight gain over time ³⁶. People who ate more red and processed meat over the course of the study gained more weight-about a pound extra every four years. People who ate more nuts over the course of the study gained less weight-about a half pound less every four years.

In another study, published in The New England Journal of Medicine in 2009 ³⁷, tested four different types of diets and producing results that showed comparable average weight loss among the different diets. The study followed 800 people over 2 years, assigning subjects to one of four diets: 1) Low-fat and average-protein; 2) low-fat and high-protein; 3) high-fat and average-protein; and 4) high-fat and high protein. Researchers concluded that all of the diets resulted in meaningful weight loss, despite the differences in macronutrient (the fat and protein) composition. The study also found that the more group counseling sessions participants attended, the more weight they lost, and the less weight they regained. This supports the idea that not only is what you eat important, but behavioral, psychological, and social factors are important for weight loss as well ³⁷.

An additional study, published in The New England Journal of Medicine in 2010 ³⁸, looked at the role of protein and glycemic index upon weight loss maintenance. Researchers first implemented a low-calorie diet to produce weight loss, then examined whether protein and glycemic index impacted weight loss maintenance. The study population was made up of nearly 800 overweight adults from European countries who had lost at least 8% of their initial body weight with a low-calorie diet. Participants were then assigned one of five diets to prevent weight regain over a 26-week period: A low-protein and low-glycemic-index diet, a low-protein and high-glycemic-index diet, a high-protein and low-glycemic-index diet, a high-protein and high-glycemic-index diet, or a control diet.

• The low-protein-high-glycemic-index diet was associated with subsequent significant weight regain and weight regain was less in the groups assigned to a high-protein diet than in those assigned to a low-protein diet, as well as less in the groups assigned to a low-glycemic-index diet than in those assigned to a high-glycemic-index diet ³⁸.
• These results show that a modest increase in protein content and a modest reduction in the glycemic index led to an improvement in maintenance of weight loss ³⁸.

• Hot peppers and Sweet peppers. Capsaicin, the compound that gives chili peppers their kick, heats up your body, which makes you melt additional calories. You can get it by eating raw, cooked, dried, or powdered peppers. Add as much cayenne or hot sauce as possible to soups, eggs, and meats.

Chili peppers are the major source of nature capsaicinoids, which consist of capsaicin, dihydrocapsaicin, nordihydrocapsaicin, homodihydrocapsaicin, and homocapsaicin, etc. Capsaicinoids are found to exert multiple pharmacological and physiological effects including the activities of analgesia, anticancer, anti-inflammation, antioxidant and anti-obesity ³⁹. Therefore, capsaicinoids may have the potential value in clinic for pain relief, cancer prevention and weight loss. In addition, capsaicinoids also display the benefits on cardiovascular and gastrointestinal system ³⁹.

Sweet peppers are the source of nature capsinoids, which share similar structure with capsaicinoids and consist of capsiate, dihydrocapsiate, and nordihydrocapsiate ³⁹. Comparing with capsaicinoids, capsinoids are less pungent and easily broken down in the normal aqueous conditions. So far, it has been found that capsinoids possess the biological properties of antitumor, antioxidant and anti-obesity ³⁹. Since capsinoids are less toxic than capsaicinoids, therefore, capsinoids may have the advantages over capsaicinoids in clinical applications such as cancer prevention and weight loss ³⁹.

Studies were conducted to investigate the effects of red pepper (capsaicin) on feeding behaviour and energy intake. In the first study, the effects of dietary red pepper added to high-fat and high-carbohydrate meals on subsequent energy and macronutrient intakes were examined in thirteen Japanese female subjects. These results indicate that the ingestion of red pepper decreases appetite and subsequent protein and fat intakes in Japanese females and energy intake in Caucasian males. Moreover, this effect might be related to an increase in sympathetic nervous system activity in Caucasian males ⁴⁰.

In a study from the British Medical Journal ⁴¹ found that people who eat spicy foods nearly every day have a 14% chance of living longer than those who consume spicy foods less than once a week, according to a new study. Regular spicy food eaters also are less likely to die from cancer and heart and respiratory diseases than those who eat spicy foods infrequently. The researchers looked at health and dietary data gathered from 487,375 people, ages 30-79, who were enrolled between 2004-2008 in the China Kadoorie Biobank. Participants with a history of cancer, heart disease, and stroke were excluded from the study. During a median follow-up of 7.2 years, there were 11,820 deaths among men and 8,404 deaths among women ⁴¹.

• Almonds, peanuts and other nuts (with skins intact).

Studies find that eating nuts does not lead to weight gain and may instead help with weight control, perhaps because nuts are rich in protein and fiber, both of which may help people feel fuller and less hungry ³⁶, ⁴², ⁴³, ⁴⁴. People who regularly eat nuts are less likely to have heart attacks or die from heart disease than those who rarely eat them, which is another reason to include nuts in a healthy diet ⁴⁵.

• Dairy products (fat-free or low-fat milk, yogurt, cheese).

The U.S. dairy industry has aggressively promoted the weight-loss benefits of milk and other dairy products, based largely on findings from short-term studies it has funded ⁴⁶, ⁴⁷. But a recent review of nearly 50 randomized trials finds little evidence that high dairy or calcium intakes help with weight loss ⁴⁸. Similarly, most long-term follow-up studies have not found that dairy or calcium protect against weight gain ⁴⁹, ⁵⁰, ⁵¹, ⁵² and one study in adolescents found high milk intakes to be associated with increased body mass index ⁵³.

One exception is the recent dietary and lifestyle change study from the Harvard School of Public Health, which found that people who increased their yogurt intake gained less weight; increases in milk and cheese intake, however, did not appear to promote weight loss or gain ³⁶. It’s possible that the beneficial bacteria in yogurt may influence weight control, but more research is needed.

• Lentils. One cup packs 35% of your daily iron needs, since up to 20% of us are iron- deficient.

• Fatty fish (such as salmon, tuna, mackerel).

• Tomatoes.

• Grapefruit.

• Ginger.

In a large population based study involving 120,877 U.S. men and women who were free of chronic diseases and not obese at baseline, with follow-up periods from 1986 to 2006, 1991 to 2003, and 1986 to 2006 ⁵⁴. The relationships between changes in lifestyle factors and weight change were evaluated at 4-year intervals, with adjustments made for age, baseline body-mass index (BMI) for each period, and all lifestyle factors simultaneously.

• Within each 4-year period, participants gained an average of 3.35 lb (1.52 kg).

On the basis of increased daily servings of individual dietary components, 4-year weight change was most strongly associated with the intake of:

• potato chips (1.69 lb),
• potatoes (1.28 lb),
• sugar-sweetened beverages (1.00 lb),
• unprocessed red meats (0.95 lb), and
• processed meats (0.93 lb)
• and weight loss was associated with the intake of vegetables (-0.22 lb), whole grains (-0.37 lb), fruits (-0.49 lb), nuts (-0.57 lb), and yogurt (-0.82 lb) ⁵⁴.

Other lifestyle factors were also independently associated with weight change, including physical activity (-1.76 lb); alcohol use (0.41 lb per drink per day), smoking (new quitters, 5.17 lb; former smokers, 0.14 lb), sleep (more weight gain with <6 or >8 hours of sleep), and television watching (0.31 lb per hour per day) ⁵⁴. The study concluded that specific dietary and lifestyle factors are independently associated with long-term weight gain. Aggregate dietary changes are critical for substantial differences in weight gain, with additional contributions from changes in physical activity and television watching, thus highlighting specific lifestyle changes that might be prioritized in obesity-prevention strategies.

Summary

The main determinants of diet-induced thermogenesis are the energy content and the protein-and alcohol fraction of the diet. Protein plays a key role in body weight regulation through satiety related to diet-induced thermogenesis ⁸.

(Source Harvard School of Public Health. Healthy Eating Plate & Healthy Eating Pyramid ⁵⁵). Use The Healthy Eating Plate as a guide for creating healthy, balanced meals—whether served on a plate or packed in a lunch box. Put a copy on the refrigerator as a daily reminder to create healthy, balanced meals.

Note:

• The Healthy Eating Plate does not define a certain number of calories or serving sizes per day from each food group. The relative section sizes suggest approximate relative proportions of each of the food groups to include on a healthy plate. They are not based on specific calorie amounts, and they are not meant to prescribe a certain number of calories or servings per day, since individuals’ calorie and nutrient needs vary based on age, gender, body size, and level of activity.

• According to research done at Harvard School of Public Health and elsewhere ⁵⁶, ⁵⁷, ⁵⁸ following the Healthy Eating Pyramid and Healthy Eating Plate guidelines can lead to a lower risk of heart disease and premature death:

Consider Food Quality, Not Just Calories

Rather than focusing on calories alone, however, emerging research shows that quality is also key in determining what you should eat and what you should avoid in order to achieve and maintain a healthy weight. Rather than choosing foods based only on caloric value, think instead about choosing high-quality, healthy foods, and minimizing low-quality foods ⁵⁹.

• High-quality foods include unrefined, minimally processed foods such as vegetables and fruits, whole grains, healthy fats and healthy sources of protein – the foods recommended in the Healthy Eating Plate.

• Lower-quality foods include highly processed snack foods, sugar-sweetened beverages, refined (white) grains, refined sugar, fried foods, foods high in saturated and trans fats, and high-glycemic foods such as potatoes.

There isn’t one “perfect” diet for everyone, owing to individual differences in genes and lifestyle.

Food Quality Counts

One study analyzed whether certain foods were more or less likely to promote weight gain. This type of research examining specific foods and drinks allows us to understand whether “a calorie is a calorie,” or if eating more higher-quality foods and fewer lower-quality foods can lead to weight loss and maintenance.

Researchers in the Department of Nutrition at Harvard School of Public Health show us that quality is in fact very important in determining what you should eat to achieve and maintain a healthy weight, and that the notion of “a calorie is a calorie” does not tell the whole story.

• In a study of over 120,000 healthy women and men spanning 20 years, researchers determined that weight change was most strongly associated with the intake of potato chips, potatoes, sugar-sweetened beverages, and both processed and unprocessed red meats. The researchers concluded that consumption of processed foods higher in starches, refined grains, fats, and sugars can increase weight gain.

• Foods shown to be associated with weight loss were vegetables, whole grains, fruits, nuts, and yogurt.

• Researchers did not discount the importance of calories, instead suggesting that choosing high-quality foods (and decreasing consumption of lower-quality foods) is an important factor in helping individuals consume fewer calories ⁵⁴.

Healthy Eating Plate & Healthy Eating Pyramid ⁵⁵

• Make most of your meal vegetables and fruits – ½ of your plate:

Aim for color and variety, and remember that potatoes don’t count as vegetables on the Healthy Eating Plate because of their negative impact on blood sugar.

• Go for whole grains – ¼ of your plate:

Whole and intact grains—whole wheat, barley, wheat berries, quinoa, oats, brown rice, and foods made with them, such as whole wheat pasta—have a milder effect on blood sugar and insulin than white bread, white rice, and other refined grains.

• Protein power – ¼ of your plate:

Fish, chicken, beans, and nuts are all healthy, versatile protein sources—they can be mixed into salads, and pair well with vegetables on a plate. Limit red meat, and avoid processed meats such as bacon and sausage.

• Healthy plant oils – in moderation:

Choose healthy vegetable oils like olive, canola, soy, corn, sunflower, peanut, and others, and avoid partially hydrogenated oils, which contain unhealthy trans fats. Remember that low-fat does not mean “healthy.”

• Drink water, coffee, or tea:

Skip sugary drinks, limit milk and dairy products to one to two servings per day, and limit juice to a small glass per day.

• Stay active:

The red figure running across the Healthy Eating Plate’s placemat is a reminder that staying active is also important in weight control.

The main message of the Healthy Eating Plate is to focus on diet quality.

• The type of carbohydrate in the diet is more important than the amount of carbohydrate in the diet, because some sources of carbohydrate—like vegetables (other than potatoes), fruits, whole grains, and beans—are healthier than others.

• The Healthy Eating Plate also advises consumers to avoid sugary beverages, a major source of calories—usually with little nutritional value—in the American diet.

• The Healthy Eating Plate encourages consumers to use healthy oils, and it does not set a maximum on the percentage of calories people should get each day from healthy sources of fat. In this way, the Healthy Eating Plate recommends the opposite of the low-fat message promoted for decades by the USDA.

Two studies offer evidence of the disease prevention benefits that accrue from following a diet similar to one based on the Healthy Eating Pyramid:

• A study that tracked 7,319 British civil servants for 18 years found that men and women with the highest scores on the Alternate Healthy Eating Index had a 25 percent lower risk of dying from any cause, and a 42 percent lower risk of dying from heart disease, than people with the lowest scores ⁵⁸.
• Another observational study in 93,676 post-menopausal women found that following a Healthy Eating Pyramid-style diet (as measured by adherence to the Alternative Healthy Eating Index) was superior to following a low-fat diet at lowering cardiovascular disease and heart failure risk ⁵⁶.

1. Tappy L. Reprod Nutr Dev. 1996;36(4):391-7. Thermic effect of food and sympathetic nervous system activity in humans. https://www.ncbi.nlm.nih.gov/pubmed/8878356/[↩]
2. Diet induced thermogenesis measured over 24h in a respiration chamber: effect of diet composition. Westerterp KR, Wilson SA, Rolland V. Int J Obes Relat Metab Disord. 1999 Mar; 23(3):287-92. https://www.ncbi.nlm.nih.gov/pubmed/10193874/[↩]
3. Influence of autonomic nervous system on nutrient-induced thermogenesis in humans. Acheson KJ. Nutrition. 1993 Jul-Aug; 9(4):373-80. https://www.ncbi.nlm.nih.gov/pubmed/8400596/[↩]
4. Satiety related to 24 h diet-induced thermogenesis during high protein/carbohydrate vs high fat diets measured in a respiration chamber. Westerterp-Plantenga MS, Rolland V, Wilson SA, Westerterp KR. Eur J Clin Nutr. 1999 Jun; 53(6):495-502. https://www.ncbi.nlm.nih.gov/pubmed/10403587/[↩]
5. Postprandial thermogenesis is increased 100% on a high-protein, low-fat diet versus a high-carbohydrate, low-fat diet in healthy, young women. Johnston CS, Day CS, Swan PD. J Am Coll Nutr. 2002 Feb; 21(1):55-61. https://www.ncbi.nlm.nih.gov/pubmed/11838888/[↩]
6. The significance of protein in food intake and body weight regulation. Westerterp-Plantenga MS. Curr Opin Clin Nutr Metab Care. 2003 Nov; 6(6):635-8. https://www.ncbi.nlm.nih.gov/pubmed/14557793/[↩]
7. Schwartz RS, Ravussin E, Massari M, O’Connell M, Robbins DC. Metabolism. 1985 Mar;34(3):285-93. The thermic effect of carbohydrate versus fat feeding in man. https://www.ncbi.nlm.nih.gov/pubmed/3883098[↩][↩]
8. Westerterp KR. Diet induced thermogenesis. Nutrition & Metabolism. 2004;1:5. doi:10.1186/1743-7075-1-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524030/[↩][↩]
9. Stob NR, Bell C, van Baak MA, Seals DR. J Appl Physiol (1985). 2007 Aug;103(2):616-22. Epub 2007 Apr 26. Thermic effect of food and beta-adrenergic thermogenic responsiveness in habitually exercising and sedentary healthy adult humans. https://www.ncbi.nlm.nih.gov/pubmed/17463294[↩]
10. Aragon AA, Schoenfeld BJ, Wildman R, et al. International society of sports nutrition position stand: diets and body composition. Journal of the International Society of Sports Nutrition. 2017;14:16. doi:10.1186/s12970-017-0174-y. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470183/[↩]
11. Zahorska-Markiewicz B. Eur J Appl Physiol Occup Physiol. 1980;44(3):231-5. Thermic effect of food and exercise in obesity. https://www.ncbi.nlm.nih.gov/pubmed/7190917[↩][↩]
12. Hall KD, Heymsfield SB, Kemnitz JW, Klein S, Schoeller DA, Speakman JR. Energy balance and its components: implications for body weight regulation. The American Journal of Clinical Nutrition. 2012;95(4):989-994. doi:10.3945/ajcn.112.036350. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3302369/[↩]
13. Speakman JR, Selman C. Physical activity and resting metabolic rate. Proc Nutr Soc 2003;62:621–34. https://www.ncbi.nlm.nih.gov/pubmed/14692598[↩]
14. LaForgia J, Withers RT, Gore CJ. Effects of exercise intensity and duration on the excess post-exercise oxygen consumption. J Sports Sci 2006;24:1247–64. https://www.ncbi.nlm.nih.gov/pubmed/17101527[↩]
15. Hill JO, Heymsfield SB, McMannus C 3rd, DiGirolamo M. Metabolism. 1984 Aug;33(8):743-9. Meal size and thermic response to food in male subjects as a function of maximum aerobic capacity. https://www.ncbi.nlm.nih.gov/pubmed/6748948[↩]
16. Tagliaferro AR, Kertzer R, Davis JR, Janson C, Tse SK. Physiol Behav. 1986;38(5):703-10. Effects of exercise-training on the thermic effect of food and body fatness of adult women. https://www.ncbi.nlm.nih.gov/pubmed/3823186 [↩]
17. Segal KR, Gutin B, Albu J, Pi-Sunyer FX. Am J Physiol. 1987 Jan;252(1 Pt 1):E110-7. http://ajpendo.physiology.org/content/252/1/E110[↩][↩]
18. Dulloo, A.G., J. Seydoux, and J. Jacquet, Adaptive thermogenesis and uncoupling proteins: a reappraisal of their roles in fat metabolism and energy balance. Physiol Behav, 2004. 83(4): p. 587-602.[↩]
19. Kinabo, J.L. and J.V. Durnin, Thermic effect of food in man: effect of meal composition, and energy content. Br J Nutr, 1990. 64(1): p. 37-44.[↩]
20. Kinabo JL, Durnin JV. Eur J Clin Nutr. 1990 May;44(5):389-95. Effect of meal frequency on the thermic effect of food in women. https://www.ncbi.nlm.nih.gov/pubmed/2387273[↩]
21. Wilhelmine P.H.G. Verboeket-Van De Venne, Klaas R. Westerterp and Arnold D.M. Kester. British Journal of Nutrition (1993), 70, 103-115. Effect of the pattern of food intake on human energy metabolism. https://www.ncbi.nlm.nih.gov/pubmed/8399092[↩][↩]
22. Thermic effect of medium-chain and long-chain triglycerides in man. Seaton TB, Welle SL, Warenko MK, Campbell RG. Am J Clin Nutr. 1986 Nov; 44(5):630-4. https://www.ncbi.nlm.nih.gov/pubmed/3532757/[↩]
23. Protein choices targeting thermogenesis and metabolism. Acheson KJ, Blondel-Lubrano A, Oguey-Araymon S, Beaumont M, Emady-Azar S, Ammon-Zufferey C, Monnard I, Pinaud S, Nielsen-Moennoz C, Bovetto L. Am J Clin Nutr. 2011 Mar; 93(3):525-34. https://www.ncbi.nlm.nih.gov/pubmed/21228266/[↩]
24. Energy balance and its components: implications for body weight regulation. Hall KD, Heymsfield SB, Kemnitz JW, Klein S, Schoeller DA, Speakman JR. Am J Clin Nutr. 2012 Apr; 95(4):989-94. https://www.ncbi.nlm.nih.gov/pubmed/22434603/[↩]
25. Diet induced thermogenesis. Westerterp KR. Nutr Metab (Lond). 2004 Aug 18; 1(1):5. https://www.ncbi.nlm.nih.gov/pubmed/15507147/[↩]
26. Kinabo JL, Durnin JV. Br J Nutr. 1990 Jul;64(1):37-44. Thermic effect of food in man: effect of meal composition, and energy content. https://www.ncbi.nlm.nih.gov/pubmed/2400767[↩]
27. Miles CW, Wong NP, Rumpler WV, Conway J. Eur J Clin Nutr. 1993 Apr;47(4):274-84. Effect of circadian variation in energy expenditure, within-subject variation and weight reduction on thermic effect of food. https://www.ncbi.nlm.nih.gov/pubmed/8491165[↩][↩]
28. Westerterp-Plantenga MS, Nieuwenhuizen A, Tome D, Soenen S, Westerterp KR. Dietary protein, weight loss, and weight maintenance. Annu Rev Nutr. 2009;29:21-41. https://www.ncbi.nlm.nih.gov/pubmed/19400750[↩][↩]
29. Halton TL, Hu FB. The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. J Am Coll Nutr. 2004;23:373-85. https://www.ncbi.nlm.nih.gov/pubmed/15466943[↩]
30. Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-41. https://www.ncbi.nlm.nih.gov/pubmed/18635428[↩]
31. Furtado JD, Campos H, Appel LJ, et al. Effect of protein, unsaturated fat, and carbohydrate intakes on plasma apolipoprotein B and VLDL and LDL containing apolipoprotein C-III: results from the OmniHeart Trial. Am J Clin Nutr. 2008;87:1623-30. https://www.ncbi.nlm.nih.gov/pubmed/18541549 [↩]
32. Appel LJ, Sacks FM, Carey VJ, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA. 2005;294:2455-64. https://www.ncbi.nlm.nih.gov/pubmed/16287956[↩]
33. Bernstein AM, Sun Q, Hu FB, Stampfer MJ, Manson JE, Willett WC. Major dietary protein sources and risk of coronary heart disease in women. Circulation. 2010;122:876-83. https://www.ncbi.nlm.nih.gov/pubmed/20713902[↩][↩]
34. Aune D, Ursin G, Veierod MB. Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies. Diabetologia. 2009;52:2277-87. https://www.ncbi.nlm.nih.gov/pubmed/19662376[↩]
35. Pan A, Sun Q, Bernstein AM, et al. Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. Am J Clin Nutr. 2011;94(4):1088-96. https://www.ncbi.nlm.nih.gov/pubmed/21831992[↩][↩]
36. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364:2392-404. https://www.ncbi.nlm.nih.gov/pubmed/21696306[↩][↩][↩]
37. Sacks, F.M., et al., Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med, 2009. 360(9): p. 859-73. https://www.ncbi.nlm.nih.gov/pubmed/19246357[↩][↩]
38. Larsen, T.M., et al., Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med, 2010. 363(22): p. 2102-13. http://www.nejm.org/doi/full/10.1056/NEJMoa1007137[↩][↩][↩]
39. Luo XJ, Peng J, Li YJ. Eur J Pharmacol. 2011 Jan 10;650(1):1-7. doi: 10.1016/j.ejphar.2010.09.074. Epub 2010 Oct 12. Recent advances in the study on capsaicinoids and capsinoids. https://www.ncbi.nlm.nih.gov/pubmed/20946891[↩][↩][↩][↩][↩]
40. Yoshioka M, St-Pierre S, Drapeau V, Dionne I, Doucet E, Suzuki M, Tremblay A. Br J Nutr. 1999 Aug;82(2):115-23. Effects of red pepper on appetite and energy intake. https://www.ncbi.nlm.nih.gov/pubmed/10743483[↩]
41. Lv Jun, Qi Lu, Yu Canqing, Yang Ling, Guo Yu, Chen Yiping et al. Consumption of spicy foods and total and cause specific mortality: population based cohort study BMJ 2015; 351 :h3942. http://www.bmj.com/content/351/bmj.h3942[↩][↩]
42. Mattes RD, Kris-Etherton PM, Foster GD. Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. J Nutr. 2008;138:1741S-5S. https://www.ncbi.nlm.nih.gov/pubmed/18716179[↩]
43. Bes-Rastrollo M, Sabate J, Gomez-Gracia E, Alonso A, Martinez JA, Martinez-Gonzalez MA. Nut consumption and weight gain in a Mediterranean cohort: The SUN study. Obesity (Silver Spring). 2007;15:107-16. https://www.ncbi.nlm.nih.gov/pubmed/17228038[↩]
44. Bes-Rastrollo M, Wedick NM, Martinez-Gonzalez MA, Li TY, Sampson L, Hu FB. Prospective study of nut consumption, long-term weight change, and obesity risk in women. Am J Clin Nutr. 2009;89:1913-19. https://www.ncbi.nlm.nih.gov/pubmed/19403639[↩]
45. Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009;169:659-69. https://www.ncbi.nlm.nih.gov/pubmed/19364995[↩]
46. Zemel MB, Shi H, Greer B, Dirienzo D, Zemel PC. Regulation of adiposity by dietary calcium. FASEB J. 2000;14:1132-8. https://www.ncbi.nlm.nih.gov/pubmed/10834935[↩]
47. Zemel MB, Thompson W, Milstead A, Morris K, Campbell P. Calcium and dairy acceleration of weight and fat loss during energy restriction in obese adults. Obes Res. 2004;12:582-90. https://www.ncbi.nlm.nih.gov/pubmed/15090625[↩]
48. Lanou AJ, Barnard ND. Dairy and weight loss hypothesis: an evaluation of the clinical trials. Nutr Rev. 2008;66:272-9. https://www.ncbi.nlm.nih.gov/pubmed/18454813[↩]
49. Phillips SM, Bandini LG, Cyr H, Colclough-Douglas S, Naumova E, Must A. Dairy food consumption and body weight and fatness studied longitudinally over the adolescent period. Int J Obes Relat Metab Disord. 2003;27:1106-13. https://www.ncbi.nlm.nih.gov/pubmed/12917718[↩]
50. Rajpathak SN, Rimm EB, Rosner B, Willett WC, Hu FB. Calcium and dairy intakes in relation to long-term weight gain in US men. Am J Clin Nutr. 2006;83:559-66. https://www.ncbi.nlm.nih.gov/pubmed/16522901[↩]
51. Snijder MB, van Dam RM, Stehouwer CD, Hiddink GJ, Heine RJ, Dekker JM. A prospective study of dairy consumption in relation to changes in metabolic risk factors: the Hoorn Study. Obesity (Silver Spring). 2008;16:706-9. https://www.ncbi.nlm.nih.gov/pubmed/18239556[↩]
52. Boon N, Koppes LL, Saris WH, Van Mechelen W. The relation between calcium intake and body composition in a Dutch population: The Amsterdam Growth and Health Longitudinal Study. Am J Epidemiol. 2005;162:27-32. https://www.ncbi.nlm.nih.gov/pubmed/15961583[↩]
53. Berkey CS, Rockett HR, Willett WC, Colditz GA. Milk, dairy fat, dietary calcium, and weight gain: a longitudinal study of adolescents. Arch Pediatr Adolesc Med. 2005;159:543-50. https://www.ncbi.nlm.nih.gov/pubmed/15939853[↩]
54. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364:2392-404. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3151731/[↩][↩][↩][↩]
55. Harvard University. Harvard School of Public Health. Healthy Eating Plate & Healthy Eating Pyramid. https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/[↩][↩]
56. Akbaraly, T.N., et al., Alternative Healthy Eating Index and mortality over 18 y of follow-up: results from the Whitehall II cohort. Am J Clin Nutr, 2011. 94(1): p. 247-53. http://ajcn.nutrition.org/content/94/1/247.full.pdf[↩][↩]
57. Belin, R.J., et al., Diet quality and the risk of cardiovascular disease: the Women’s Health Initiative (WHI). Am J Clin Nutr, 2011. 94(1): p. 49-57. http://ajcn.nutrition.org/content/94/1/49.full[↩]
58. McCullough, M.L., et al., Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr, 2002. 76(6): p. 1261-71. https://www.ncbi.nlm.nih.gov/pubmed/12450892[↩][↩]
59. Harvard University. Harvard School of Public Health. The Best Diet: Quality Counts. https://www.hsph.harvard.edu/nutritionsource/best-diet-quality-counts/[↩]