Egg Nutrition Center Blog

New Directions in Macronutrient Distribution at AAPA Conference 2014


Last month, physician assistants gathered from far and wide in Boston, Massachusetts for their annual professional development-filled Memorial Day weekend event, the American Academy of Physician Assistants (AAPA) Impact Conference. Eager to explore the various educational sessions, workshops and career expansion opportunities, PAs were surely not disappointed by the impressive pool of resources made available.

One of the first product theater presentations of the conference (New Directions in Macronutrient Intake and Weight Management: Moving from Science to Solutions) was by the Egg Nutrition Center’s Senior Director of Nutrition Research and Communications, Tia Rains, PhD. Over breakfast, Dr. Rains discussed the changing dietary patterns over the past 30 years, explored the history of public health recommendations during that time and highlighted the ever-evolving paradigm for macronutrient intakes. After examining the latest scientific evidence, Dr. Rains translated research findings into practical applications for PAs to help individuals build healthy meals.

Dr. Rains described how dietary trends, including the “fat phobia” that comprised the past half-century, have led Americans to develop dietary habits characterized by an unideal distribution of macronutrient intake throughout the day. This has been fueled, at least in part, by decreases in the consumption of red meat, whole milk and eggs (1) and increases in grain product consumption, particularly from snacks (2). Interestingly, though partially stemming from recommendations of respected health organizations, these habits have been decidedly unsuccessful in reducing rampant rates of overweight, obesity and related chronic illnesses (3).

To achieve the wide range of benefits of optimal macronutrient distribution, the most recent body of evidence suggests a need for slightly higher protein intake than is typically consumed, particularly shifting protein intake towards higher intakes at the morning meal. While the American diet often contains the majority of protein intake at dinner, studies show that stimulation of muscle protein synthesis and greater satiety requires at least 25 grams of protein in one sitting (4). Therefore, evenly distributing protein intake throughout the day, aiming for 25-30 grams of protein in each meal, may maximize the benefits of protein versus a skewed distribution (5).

The benefits of consuming dietary protein at levels that exceed the minimum recommended daily amount (0.8 g/kg body weight/d) are vast, with research showing positive effects on satiety, blood glucose modulation, the blood lipid profile (specifically, plasma triglycerides), body composition and weight maintenance (6). Studies continue to elucidate the mechanisms behind these benefits, with most recent discoveries supporting increased satiety hormones, augmented thermic effect of food and heightened resting rates of metabolism (7,8). Importantly, increased protein intakes have also been associated with management or prevention of obesity, heart disease, metabolic syndrome, type 2 diabetes, osteoporosis and sarcopenia (9).

After an in-depth discussion of the latest research on macronutrient distribution, Dr. Rains shared healthy, protein-rich breakfast options for physician assistants to share with their patients in order to help them reach optimal protein intakes at their morning meals. Greek yogurt parfaits, egg sandwiches on whole grain bread and cottage cheese with fruit are all delicious choices that can contain optimal amounts of protein.

If you’re looking for additional information on this topic, feel free to check out ENC’s Patient/Client Education Materials. What was your favorite educational session at AAPA this year? We’d love to hear from you, so please reply in the comment section below!



1)      Harnack LJ, Jeffry RW, Boutelle KN. Temporal trends in energy intake in the United States: an ecological perspective. Am J Clin Nutr. 2000; 71(6):1478-84.

2)      Briefel RR, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr. 2004; 24:401-31.

3)      Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among U.S. adults, 1999-2010. JAMA. 2012; 307(5):491-497.

4)      Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care. 2009;12:86-90.

5)      Mamerow MM, Mettler JA, English KL, Casperson SL, Arentson-Lantz E, Sheffield-Moore M, Layman DK, Paddon-Jones D. J Nutr. 2014; 144(6):876-80.

6)      Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, DC: National Academies Press, 2005.

7)      Leidy HJ, Bossingham MJ, Mattes RD, Campbell WW. Increased dietary protein consumed at breakfast leads to an initial and sustained feeling of fullness during energy restriction compared to other meal times. Br J Nutr. 2009; 101(6):798-803.

8)      Wycherley TP, Moran LJ, Clifton PM, Noakes M, Brinkworth GD. Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2012; 96:1281-98.

9)      Protein summit 2007: exploring the impact of high-quality protein on optimal health. Am J Clin Nutr. 2008;87:1515S-1581S.

Author: Anna Shlachter MS, RDN, LDN