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Obes Rev. 2018 Sep;19(9):1205-1235. doi: 10.1111/obr.12699. Epub 2018 May 14.

Pathways and mechanisms linking dietary components to cardiometabolic disease: thinking beyond calories.

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Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA.
Department of Preventive Medicine, Diabetes and Obesity Research Institute, University of Southern California, Los Angeles, CA, USA.
Institute of Human Nutrition and Food Science, Christian-Albrechts-Universität zu Kiel, Kiel, Germany.
Children's Hospital Oakland Research Institute, Oakland, CA, USA.
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
California Clinical and Translational Science Institute, University of California, San Francisco, San Francisco, CA, USA.
Department of Anthropology, History, and Social Medicine, University of California, San Francisco, San Francisco, CA, USA.
Touro University, Vallejo, CA, USA.
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Oregon Research Institute, Eugene, OR, USA.
Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Department of Microbiology and Immunology, G.W. Hooper Research Foundation, University of California, San Francisco, San Francisco, CA, USA.
Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Department of Nutrition, University of California, Davis, Davis, CA, USA.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Psychiatry, Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA.
Division of Molecular Genetics, Department of Pediatrics, Columbia University, New York, NY, USA.
Department of Pediatrics, Emory University School of Medicine, Wellness Department, Children's Healthcare of Atlanta, Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
Department of Nutrition, Exercise, and Sports, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark.


Calories from any food have the potential to increase risk for obesity and cardiometabolic disease because all calories can directly contribute to positive energy balance and fat gain. However, various dietary components or patterns may promote obesity and cardiometabolic disease by additional mechanisms that are not mediated solely by caloric content. Researchers explored this topic at the 2017 CrossFit Foundation Academic Conference 'Diet and Cardiometabolic Health - Beyond Calories', and this paper summarizes the presentations and follow-up discussions. Regarding the health effects of dietary fat, sugar and non-nutritive sweeteners, it is concluded that food-specific saturated fatty acids and sugar-sweetened beverages promote cardiometabolic diseases by mechanisms that are additional to their contribution of calories to positive energy balance and that aspartame does not promote weight gain. The challenges involved in conducting and interpreting clinical nutritional research, which preclude more extensive conclusions, are detailed. Emerging research is presented exploring the possibility that responses to certain dietary components/patterns are influenced by the metabolic status, developmental period or genotype of the individual; by the responsiveness of brain regions associated with reward to food cues; or by the microbiome. More research regarding these potential 'beyond calories' mechanisms may lead to new strategies for attenuating the obesity crisis.


Cardiometabolic disease; dietary fat; dietary sugar; obesity

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