Skip to main content
    • Aa
    • Aa

Consequences of food energy excess and positive energy balance

  • Ricardo Uauy (a1) and Erik Díaz (a1)

This paper discusses possible consequences of energy excess throughout the life cycle. Firstly we consider the effects of foods on hunger, satiety and satiation. Also, the changes in food availability and consumption in relation to changes in social and economic determinants of energy excess. The relationship between physical activity and energy intake (EI) is also considered. Secondly we explore the definition of energy excess and the metabolic effects of macronutrients (mainly in relation to fuel partitioning oxidation/storage) on energy balance. The cellular and molecular regulation determined by specific genes involved in lipogenesis, fuel partitioning and/or in energy dissipation are explored. Thirdly, we examine the main consequences induced by energy excess and positive energy balance, starting with the alterations in glucose utilisation (insulin resistance) leading to type 2 diabetes and the linkage of energy excess with other non-communicable diseases (NCDs). Biological, social and psychological consequences during perinatal, childhood and adolescence periods are specifically analysed. Fourthly, the transition from energy deficit to excess, under the optic of a developing country is analysed with country examples drawn from Latin America. The possible role of supplementary food programmes in determining positive energy balance is discussed especially in relation to pre-school and school feeding programmes. Fifthly, we deal with the economic costs of energy excess and obesity related diseases. Finally, some areas where further research is needed are described; biological and genetic determinants of individual and population energy requirements, foods and food preparations as actually consumed, consumer education and research needs on social determinants of energy imbalances.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Consequences of food energy excess and positive energy balance
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Consequences of food energy excess and positive energy balance
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Consequences of food energy excess and positive energy balance
      Available formats
Corresponding author
*Corresponding author: Email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

3A Drewnosky . Macronutrient substitutes and weight reduction practices of obese, dieting and eating disordered women. Annals of the New York Academy of Sciences 1997; 819: 132–41.

6JE Blundell , RJ Stubbs . High and low carbohydrate and fat intakes: limits imposed by appetite and palatability and their implications for energy balance. European Journal of Clinical Nutrition 1999; 53(Suppl. 1): S148–65.

13EE Blaak , W Saris . Postprandial thermogenesis and substrate utilization after ingestion of different dietary carbohydrates. Metabolism Clinical and Experimental 1996; 45: 1235–42.

18MK Hellerstein . De novo lipogenesis in humans; metabolic and regulatory aspects. European Journal of Clinical Nutrition 1999; 53: S63S65.

20D Ludwig , J Majzoub , A Al-Zahrani , G Dallal , I Blanco , S Roberts . High glycemic index foods, overeating and obesity. Pediatrics 1999; 103: E261–6.

21DA Booth , A Chase , AT Campbell . Relative efectiveness of protein in the late stages of appetite supression in man. Physiology and Behavior 1970; 5: 1299–302.

23Aj Hill , LD Magson , JE Blundell . Hunger and palatability: tracking ratings of subjective experience before, during and after food consumption of preferred food. Appetite 1986; 5: 361–71.

24AA Geliebter . Effects of equicaloric loads of protein, fat and carbohydrate on the food intake in the rat and man. Physiology and Behavior 1978; 22: 267–73.

30NA King , A Tremblay , JE Blundell . Effects of exercise on appetite control: implications for energy balance. Medicine and Science in Sports and Exercise 1997; 29: 1076–89.

32C Albala , F Vio . Epidemiological transition in Latin America: the case of Chile. Public Health 1995; 109: 431–42.

33BM Popkin . Nutritional patterns and transition. Population and Development Reviews 1993a; 19: 138–57.

43A Valenzuela , R Uauy . Consumption pattern of dietary fats in Chile: n3 and n6 fatty acids. International Journal of Food Sciences and Nutrition 1999; 50: 127–33.

46AM Prentice . Fires of life: the struggles of an ancient metabolism in a modern world. Food and Nutrition Bulletin 2001; 26: 1327.

52Y Kabir , T Ide . Activity of hepatic fatty acid oxidation enzymes in rats fed alpha-linolenic. Biochimica et Biophysica Acta 1996; 1304: 105–19.

55M Stock . Gluttony and thermogenesis revisited. International Journal of Obesity 1999; 23: 1105–17.

62S Krief , F Lonnqvist , S Raimbault , B Baude , A Van Spronsen , P Arner , A Strosberg , D Rickier , L Emorine . Tissue distribution of beta-3 adrenergic receptor mRNA in man. Journal of Clinical Investigation 1993; 91: 344–9.

63F Lohnnqvist , A Thorne , K Nilsell , J Hofftedt , P Arner . A pathogenetic role of visceral fat beta-3 adrenoreceptors in obesity. Journal of Clinical Investigation 1995; 95: 1109–16.

64N Sakane , T Yoshida , T Umekawa , M Kondo , Y Sakai , T Takahashi . Beta-3 adrenergic receptor polymorphism: a genetic marker for visceral fat obesity and the insulin resistance syndrome. Diabetologia 1997; 40: 200–4.

66V Large , L Hellstrom , S Reynisdottir , F Lonnqvist , P Ericksson , L Lannfelt , P Arner . Human beta-2 adrenoceptor gene polimorphisms adrenoceptor function. Journal of Clinical Investigation 1997; 100: 3005–13.

67H Oberkofler , H Esterbauer , E Hell , F Krempler , W Patsch . The Gln27Glu polymorphism in the beta-2 adrenergic receptor gene is not associated with morbid obesity in Austrian women. International Journal of Obesity 2000; 24: 388–90.

68A Meirhaeghe , N Hebecque , D Cottel , P Amouyel . Beta-2 adrenoceptor gene poimorphism, body weight and physical activity. Lancet 1999; 353: 896.

69R Rosmond , O Ukkola , M Chagnon , C Bouchard , P Bjorntorp . Polymorphisms of the beta-2 adrenergic receptor gene in relation to cardiovascular risk factors in men. Journal of Internal Medicine 2000; 248: 239–44.

70M Klannemark , M Orho , L Groop . No relationship between variants in the UCP2 gene and energy expenditure. European Journal of Endocrinology European Federation of Endocrine Societies 1998; 139: 217–21.

71M Chung , A Luke , R Cooper . Genetic and physiologic analysis of the role of UCP3 in human energy homeostasis. Diabetes 1999; 48: 1890–5.

74A Shalev , C Siegrist-Kaiser , P Yen , W Wahli , A Burger , W Chin , C Meier . The peroxisome proliferator-activated receptor a is a phosphoprotein: regulation by insulin. Endocrinology 1996; 137: 4499–505.

75A Vidal-Puig , R Considine , M Jimenez-Liñan , A Werman , W Pories , J Caro , J Flier . Peroxisome proliferator-activated receptor gene expression in human tissues. Journal of Clinical Investigation 1997; 99: 2416–22.

76M Ristow , D Muller-Wieland , A Pfeiffer , W Krone , R Kahn . Obesity associated with a mutation in a genetic regulator of adipocyte differentiation. New England Journal of Medicine 1998; 339: 953–9.

78J Moitra , MM Mason , M Olive , D Krylov , O Gavrilova , B Marcus , L Feigenbaum , E Lee , T Aoyama , M Eckhaus , ML Reitmann , C Vinson . Life without fat: a transgenic mouse. Genes and Development 1998; 12: 3168–81.

79G Martin , K Schoonjans , B Staels , J Auwerx . PPAR-γ activators improve glucose homeostasis by stimulating fatty acid uptake in the adipocytes. Atherosclerosis 1998; 137: 7580.

80Z Wu , Y Xie , RF Morrison , NL Bucher , SR Farmer . PPAR-γ induces the insulin dependent glucose transporter GLUT-4 in abscence of C/EBP α during the conversion of 3T3 fibroblast into adipocytes. Journal of Clinical Investigation 1998; 101: 2232.

81S Rocchi , J Auwerx . Peroxisome proliferator activated receptor-γ, the ultimate liaison between fat and transcription. British Journal of Nutrition 2000; 84(Suppl. 2): S223–7.

82S Deeb , L Fajas , M Nemoto , M Laakso , W Fujimoto , J Auwerx . A Pro12Ala substitution in the human peroxisome PPAR-γ2 is associated with decreased receptor activity, improved insulin sensitivity, and lowered body mass index. Nature Genetics 1998; 20: 284–7.

83CJ Yen , BA Beamer , C Negri , K Silver , KA Brown , DP Yarnall , DK Burns , J Roth , AR Shuldiner . Mollecular scanning of the human PPAR gamma gene in diabetics caucasians; identification of a Pro12Ala PPAR gamma 2 missense mutation. Biochemical and Biophysical Research Communications 1997; 241: 270–4.

84BA Beamer , CJ Yen , Andersen , Association of the Pro12Ala variant in PPAR gamma 2 gene with obesity in two Caucasian populations. Diabetes 1998; 47: 1806–8.

85Y Mori , H Kim-Motoyama , T Katakura , K Yasuda , H Kadowaki , BA Beamer , AR Shuldiner , Y Akanuma , Y Yazaki , T Kadowaki . Effect of the Pro12Ala variant of the human PPAR gamma 2 on adiposity, fat distribution and insulin sensitivity in Japanese men. Biochemical and Biophysical Research Communications 1998; 251: 195–8.

86J Ek , SA Urhammer , TI Sorensen , T Andersen , J Auwerx , O Pedersen . Homozygosity of the Pro12Ala variant of PPAR gamma 2: divergent modulating effects on body mass index in obese and lean men of Caucasian origin. Diabetologia 1999; 42: 892–5.

87GM Reaven . Role of insulin resistance in human disease. Diabetes 1988; 37: 1595–607.

88A Rosenblum , JR Joe , RS Young , WE Winter . Emerging epidemic of type II diabetes in youth. Diabetes Care 1999; 22: 345–54.

89M Stumvoll , S Jacob . Multiple sites of insulin resistance: muscle, liver and adipose tissue. Experimental and Clinical Endocrinology and Diabetes: Official Journal, German Society of Endocrinology and German Diabetes Association 1999; 107: 107–10.

90L Storlien , D Pan , A Kriketos , J Connor , I Caterson , G Cooney , AB Jenkins , LA Baur . Skeletal muscle membrane lipids and insulin resistance. Lipids 1996; 31: S261–5.

91D Pan , S Lillioja , M Milner , A Kriketos , L Baur , C Bogardus , LH Storlien . Skeletal muscle membrane lipid composition is related to adiposity and insulin action. Journal of Clinical Investigation 1995; 96: 2802–8.

92GI Shulman . Cellular mechanisms of insulin resistance. Journal of Clinical Investigation 2000; 106(2): 171–6.

93G Hotamisligil , N Shargill , B Spiegelman . Adipose expression of Tumor Necrosis Factor-α: direct role in obesity-linked insulin resistance. Science 1993; 259: 8793.

94M Saghizadeh , J Ong , T Garvey , R Henry , P Kern . The expression of TNF-α by human muscle. Journal of Clinical Investigation 1996; 97: 1111–6.

95E Ferrannini , A Natali , P Bell , P Cavallo-Perin , N Lalic , G Mingrone . Insulin resistance and hypersecretion in obesity. Journal of Clinical Investigation 1997; 100: 1166–73 on behalf of the European Group for the Study of Insulin Resistance (EGIR).

96S Lillioja , DM Mott , BV Howard , PH Bennett , H Yki-Jarvinen , D Freymond , BL Nyomba , F Zurlo , B Swinburn , C Bogardus . Impaired glucose tolerance as a disorder of insulin action. Longitudinal and cross-sectional studies in Pima indians. New England Journal of Medicine 1988; 318: 1217–25.

97DK Granner , RM O'Brien . Molecular physiology and genetics of NIDDM. Diabetes Care 1992; 15: 369–95.

98CN Hales , DJ Barker . Type 2 (non-insulin dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 1992; 35: 595601.

99JP Depres , P Mauriege , B Cantin , GR Dagenais , S Moorjani , PJ Lupien . Hyperinsulinemia as an independent risk factor for ischemic heart disease. New England Journal of Medicine 1996; 334: 952–7.

100EJM Feskens , D Kromhout . Hyperinsulinemia, risk factors and coronary heart disease. The Zuphen elderly study. Arteriosclerosis and Thrombosis: a Journal of Vascular Biology American Heart Association 1994; 14: 1641–7.

103SK Cheema , MT Clandinin . Diet fat alters expression of genes for enzymes of lipogenesis in lean and obese mice. Biochimica et Biophysica Acta 1996; 1299: 284–8.

104R Bergman , S Mittelman . Central role of the adipocyte in insulin resistance. Journal of Basic and Clinical Physiology and Pharmacology 1998; 9(2–4): 205–21.

106SR Colberg , JA Simoneau , FL Thaete , DE Kelley . Skeletal muscle utilization of free fatty acid in women with visceral obesity. Journal of Clinical Investigation 1995; 95: 1846–53.

108M Shimabukuro , YT Zhou , M Levi , RH Unger . Fatty acid-induced beta cell apoptosis: a link between obesity and diabetes. Proceedings of the National Academy of Sciences of the United States of America 1998; 95: 2498–502.

110T Scantlebury , M Maslowska , K Cianflone . Chylomicron specific enhancement of acylation stimulating protein (ASP) and precursor protein C3 production in differentiated human adipocytes. Journal of Biological Chemistry 1998; 273: 20903–9.

112E Ferrannini , G Buzzigoli , MA Giorico , M Oleggini , L Graziadei , R Pedrinelli , L Brandi , S Bevilacqua . Insulin resistance in essential hypertension. New England Journal of Medicine 1987; 317: 350–7.

113GM Reaven . Relationship between insulin resistance and hypertension. Diabetes Care 1991; 14: 33–8.

114RA De Fronzo , E Ferranini . Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia and atheroesclerotic cardiovascular disease. Diabetes Care 1991; 14: 173–94.

116R Roubenoff , MJ Klag , LA Mead , KY Liang , AJ Seidler , MC Hochberg . Incidence and risk factors for gout in white men. Journal of the American Medical Association 1991; 266: 3004–7.

117DT Felson , Y Zhang , JM Anthony , A Naimark , JJ Anderson . Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham study. Annals of Internal Medicine 1992; 116: 535–9.

118AN Vgontzas , TL Tan , EO Bixler , LF Martin , D Shubert , K Kales . Sleep apnea and sleep disruption in obese patients. Archives of Internal Medicine 1994; 154: 1705–11.

119PJ Strollo , RM Rogers . Current concepts: obstructive sleep apnea. New England Journal of Medicine 1996; 334: 99104.

120A Abraham , G Collins , M Nordsieck . Relationship of childhood weight status to morbidity in adults. HSMHA Health Reports 1971; 86: 73.

122A Must , PF Jacques , GE Dallal , CJ Bajema , WH Dietz . Long-term morbidity and mortality of overweight adolescents. New England Journal of Medicine 1992; 327: 1350–5.

125RC Klesges , CK Haddock , RJ Stein , LM Klesges , LH Eck , CL Hanson . Relationship between psychosocial functioning and body fat in preschool children: a longitudinal investigation Journal of Consulting and Clinical Psychology 1992; 60: 793–6.

126R Strauss . Childhood obesity and self-esteem. Pediatrics 2000; 105: 15.

129A Sinaiko , R Donahue , D Jacbos , R Prineas . Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipids in young adults. The Minneapolis children's blood pressure study. Circulation 1999; 99: 1471–6.

130RM Lauer , WE Connor , PE Leaverton , MA Reiter , WR Clarke . Coronary heart disease risk factors in school children: The Muscatine study. Journal of Pediatrics 1975; 86: 697706.

131J Steinberger , C Morehead , V Katch , AP Rocchini . Relationship between insulin resistance and abnormal lipid profile in obese adolescents. Journal of Pediatrics 1995; 126: 690–5.

133O Pinhas-Hamiel , L Dolan , S Daniels , D Standiford , P Khoury , P Zeitler . Increased incidence of non-insulin dependent diabetes mellitus among adolescents. Journal of Pediatrics 1996; 128: 608–15.

134W Bao , SR Strinivasan , WA Wattigney , GS Berenson . Persistence of multiple cardiovascular risk clustering related to syndrome X from childhood to young adulthood. The Bogalusa heart study. Archives of Internal Medicine 1994; 154: 1842–7.

135OT Raitakari , KV Porkka , L Rasanen , T Ronnemaa , JS Viikari . Clustering and six year cluster-tracking of serum total cholesterol, HDL-cholesterol and diastolic blood pressure in children and young adults. The cardiovascular risk in young Finns study. Journal of Clinical Epidemiology 1994; 47: 1085–93.

136H Noguchi , Y Tazawa , F Nishinomiya , G Takada . The relationship between serum transaminase activities and fatty liver in children with simple obesity. Acta Paediatrica Japonica 1995; 37: 621–5.

137RT Loder . The demographics, of slipped capital femoral epiphysis. An international multicenter study. Clinical Orthopaedics and Related Research 1996; 322: 827.

138WH Dietz , WL Gross , JA Kirkpatrick . Blount disease (tibia vara): another skeletal disorder associated with childhood obesity. Journal of Pediatrics 1982; 101: 735–7.

139RC Henderson , WB Greene . Etiology of late-onset tibia vara: is varus alignment a prerequisite? Journal of Pediatric Orthopedics 1994; 14: 143–6.

140JM Silvestri , DE Weese-Mayer , MT Bass , AS Kenny , SA Hauptman , SM Pearsall . Polysomnography in obese children with a history of sleep-associated breathing disorders. Pediatric Pulmonology 1993; 16: 124–9.

143K Spiegel , R Leproult , E Van Cauter . Impact on sleep debt on endocrine and metabolic function. Lancet 1999; 354: 1435–9.

145SS Crane , Wojtowycz , TD Dye , RH Aubry , R Artal . Association between prepregnancy obesity and the risk of cesarean delivery. Obstetrics and Gynecology 1997; 89: 213–6.

147K Kallen . Maternal smoking, body mass index, and neural tube defects. American Journal of Epidemiology 1998; 147: 1103–11.

148GM Shaw , EM Velie , D Schaffer . Risk of neural tube defect affected pregnancies among obese women. Journal of the American Medical Association 1996; 275: 1093–6.

149D Waller , JL Mills , JL Simpson , GC Cunningham , MR Conley , MR Lassman , GG Rhoads . Are obese women at higher risk for producing malformed offspring? American Journal of Obstetrics and Gynecology 1994; 170: 54–8.

151MM Werler , C Louik , S Shapiro , AA Mitchell . Pre-pregnant weight in relation to risk of neural tube defects. Journal of the American Medical Association 1996; 275: 1089–92.

152S Cnattinguis , R Bergstrom , L Lipworth , S Kramer . Prepregnancy weight and the risk of adverse pregnancy outcomes. New England Journal of Medicine 1998; 338: 147–52.

153CG Solomon , WC Wilett , VJ Carey , J Rich-Edwards , DJ Hunter , GA Colditz , MJ Stampfer , FE Speizer , D Spiegelman , JE Manson . A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA Journal of the American Medical Association 1997; 278: 1078–83.

154MS Magee , CE Walden , TJ Benedetti , RH Knopp . Influence of diagnostic criteria on the incidence of gestational diabetes and perinatal morbidity. JAMA Journal of the American Medical Association 1992; 269: 609–15.

155R Thadhani , MJ Stampfer , DJ Hunter , JE Manson , CG Solomon , GC Curhan . High body mass index and hypercholesterolemia: risk of hypertensive disorders of pregnancy. Obstetrics and Gynecology 1999; 94: 543–50.

156JW Rich-Edwards , MB Goldman , WC Willett , DJ Hunter , MJ Stampfer , GA Colditz . Adolescent body mass index and infertility caused by ovulatory disorder. American Journal of Obstetrics and Gynecology 1994; 171: 171–7.

158GW Bates , NS Whitworth . Effect of body weight reduction of plasma androgens in obese, infertile women. Fertility and Sterility 1982; 38: 406–9.

160FE Harlass , SR Pylmate , BL Fariss , RP Belts . Weight loss is associated with correction of gonadotrophin and sex steroid abnormalities in the obese annovulatory female. Fertility and Sterility 1984; 42: 649–52.

161M Hollmann , B Runnebaum , I Gerhard . Effects of weight loss on the hormonal profile in obese, infertile women. Human Reproduction 1996; 11: 1884–91.

162DS Kiddy , D Hamilton-Fairley , M Seppala , R Koistinem , VH Jones , MJ Reed , S Franks . Diet-Induced changes in sex hormone binding globulin and free testosterone in women with normal or polycstic overies: Correlation with serum, insulin and insulin-like growth factor-1. Clinical Endocrinology 1989; 31: 757–63.

163DS Kiddy , D Hamilton-Fairley , A Bush , F Short , V Anyaoku , MJ Reed , S Franks . Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clinical Endocrinology 1992; 36: 105–11.

164DJ Chapman , R Perez-Escamilla . Identification of risk factors for delayed onset of lactation. Journal of the American Dietetic Association 1999; 99: 450–4.

166CN Hales , DJ Barker , PM Clark , LJ Cox , C Fall , C Osmond , PD Winter . Fetal and infant growth and impaired glucose tolerance at age 64. British Medical Journal 1991; 303: 1019–22.

167S Robinson , RJ Walton , PM Clark , DJ Barker , CN Hales , C Osmond . The relation of fetal growth to plasma glucose in young men. Diabetologia 1992; 35: 444–6.

168A Snoeck , C Remacle , B Reussens , JJ Hoet . Effect of a low protein diet during pregnancy on the fetal rat endocrine pancreas. Biology of the Neonate 1990; 57: 107–8.

169S Dahri , A Snoeck , B Reussens-Billen , C Remacle , JJ Hoett . Islet function in offspring of mothers on low-protein diet during gestation. Diabetes 1991; 40(Suppl. 2): 115–20.

171BD Mitchell , R Valdez , HP Hazuda , SM Haffner , A Monterrosa , MP Stren . Differences in the prevalence of diabetes and impaired glucose tolerance according to maternal or paternal history of diabetes. Diabetes Care 1993; 16: 1262–7.

172DJ Pettitt , HR Baird , MJ Carraher , PH Bennett , WC Knowler . Congenital susceptibility to NIDDM. Role of intrauterine environment. Diabetes 1988; 37: 622–8.

173K Langford , W Blum , K Nicolaides , J Jones , A Mc Gregor , J Miell . The pathophysiology of the insulin like growth axis in fetal growth failure: a basis for programming by undernutrition? European Journal of Clinical Investigation 1994; 24(12): 851–6.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *