Rational and design of an overfeeding protocol in constitutional thinness: Understanding the physiology, metabolism and genetic background of resistance to weight gain.

Abstract Background Constitutional thinness (CT) is a natural state of underweight (13–17.5 kg/m 2 ) without the presence of any eating disorders and abnormal hormonal profile, and with preserved menses in women. We previously conducted a four-week fat overfeeding study showing weight gain resistance in CT women and one of our main results was the identification of an energy gap: a positive energy balance (higher energy intake than energy expenditure). Objective This new overfeeding study is designed to confirm the energy gap and propose mechanistic hypothesis. Design A 2-week overfeeding (daily consumption of one bottle of Renutryl ® Booster (600 kcal, 30 g protein, 72 g carbohydrate, 21 g fat) on top of the dietary intake) is performed to compare 15 women and men in each CT group (Body Mass Index [BMI]  2 ) to their controls (BMI 20–25 kg/m 2 ). Bodyweight, food intake, energy expenditure (canopy, calorimetric chamber and Actiheart), body composition (DXA), appetite regulatory hormone profiles after a test meal, proteomics, metabolomics, urinary metabolic profiles, stool microbiome and lipids, fat and muscle transcriptomics are monitored before and after overfeeding. Results and conclusions Data inter-linking will be able to be established with results of this study. The findings could possibly open to therapeutic approaches to help CT patients to gain weight as well as provide a better understanding of energy regulation with regard to treat obesity (resistance to weight loss), a mirror image of CT (resistance to weight gain).