Brennan IM, Luscombe-Marsh ND, Seimon RV, Otto B, Horowitz M, Wishart JM, Feinle-Bisset C. Effects of fat, protein, and carbohydrate and protein load on appetite, plasma cholecystokinin, peptide YY, and ghrelin, and energy intake in lean and obese men. Am J Physiol Gastrointest Liver Physiol 303: G129 -G140, 2012. First published April 30, 2012 doi:10.1152/ajpgi.00478.2011.-While protein is regarded as the most satiating macronutrient, many studies have employed test meals that had very high and unsustainable protein contents. Furthermore, the comparative responses between lean and obese subjects and the relationships between energy intake suppression and gut hormone release remain unclear. We evaluated the acute effects of meals with modest variations in 1) fat, protein, and carbohydrate content and 2) protein load on gastrointestinal hormones, appetite, and subsequent energy intake in lean and obese subjects. Sixteen lean and sixteen obese men were studied on four occasions. Following a standardized breakfast, they received for lunch: 1) high-fat (HF), 2) high-protein (HP), 3) high-carbohydrate/low-protein (HC/LP), or 4) adequateprotein (AP) isocaloric test meals. Hunger, fullness, and gut hormones were measured throughout, and at t ϭ 180 min energy intake at a buffet meal was quantified. In lean subjects, hunger was less and fullness greater following HF, HP, and AP compared with HC/LP meals, and energy intake was less following HF and HP compared with HC meals (P Ͻ 0.05). In the obese subjects, hunger was less following HP compared with HF, HC/LP, and AP meals, and energy intake was less following HP and AP compared with HF and HC meals (P Ͻ 0.05). There were no major differences in hormone responses to the meals among subject groups, but the CCK and ghrelin responses to HP and AP were sustained in both groups. In conclusion, HP meals suppress energy intake in lean and obese subjects, an effect potentially mediated by CCK and ghrelin, while obese individuals appear to be less sensitive to the satiating effects of fat. diet composition; obesity; protein intake; dietary macronutrients; gut hormone release THE CURRENT AVERAGE WESTERN diet derives ϳ50% of energy from carbohydrate, 35% from fat, and 15% from protein (35), which represents a shift toward an increased carbohydrate and reduced protein intake when compared with the diet of our hunter-gatherer ancestors (14). Of the dietary macronutrients, protein is generally regarded as the most satiating nutrient. Accordingly, one dietary strategy for the management of obesity has been to replace some carbohydrate in the diet with protein (2,19,49), although the benefit of this approach remains uncertain (24,29,48). A recent study indicated that in obese subjects weight regain after a 26-wk period was less (by 930 g) in response to a high-protein diet (25% energy from protein), compared with a low-protein diet (13% energy from protein) (29). There is little definitive information about the comparative effects of the three macronutrients or differences in protein l...