Contents - Previous - Next


Butte NF, Wong WW & Garza C (1989): Energy cost of growth during infancy. Proc. Nutr. Soc. 48, 303-312.

Butte NF, Wong W. Garza C, Ferlic L, Smith EO & Klein PD (1990a): Energy expenditure and deposition of breast-fed and formula-fed infants during infancy. Pediatr Res 28, 631-640.

Butte NF, Smith EO & Garza C (1990b): Energy utilization of breast fed and formula-fed infants. Am. J. Clin. Nutr. 51, 350-358.

Butte NF, Villalpando S. Wong WW, Flores-Huerta S. Hernandez-Beltran M & Smith EO (1993): Higher total energy expenditure contributes to growth faltering in breast-fed infants living in rural Mexico. J. Nutr. 123,1028-1035.

Butte NF, Wills C, Jean CA, Smith EO & Garza C (1985): Feeding patterns of exclusively breast-fed infants during the first four months of life. Ear. Hum. Devel. 12, 291-300.

Butte NF, Garza C, Smith EO & Nichols BL (1984): Human milk intake and growth in exclusively breast-fed infants. J. Pediatr. 104, 187-195.

Davies PSW, Ewing G & Lucas A (1989): Energy expenditure in early infancy. Br. J. Nutr. 62, 621-629.

Davies PSW, Day JME & Lucas A (1991): Energy expenditure in early infancy and later body fatness. Intl. J. Obesity 15, 727-731.

Davies PSW (1992): Energy requirements and energy expenditure in infancy. Eur. J. Clin. Nutr. 46 (Suppl 4): S29-S35.

Dewey KG, Heinig MJ, Nommsen LA & Lönnerdal B (1991): Adequacy of energy intake among breast-fed infants in the Darling study, Relationships to growth velocity, morbidity, and activity levels. J. Pediatr. 119, 538-547.

Dewey KG, Finley DA & Lönnerdal B (1984): Breast milk volume and composition during late lactation (7-20 months). J. Pediatr. Gastroenterol. Nutr. 3, 713-720.

Dewey KG, Lönnerdal B (1983): Milk and nutrient intake of breast fed infants from I to 6 months, relation to growth and fatness. J. Pediatr. Gastroenterol. Nutr. 2, 497-506.

Dixon WJ (ed) (1990): BMDPIR, Biomedical computer programs. Biomedical computer programs. Berkeley, CA: Univ of CA.

Doyle LN & Sinclair JC (1982): Insensible water loss in newborn infants. Clin. Perinatology 9, 453-482.
FAO/WHO/UNU Expert Consultation (1985): Energy and protein requirements. World Health Organization Technical Report Series 724. Geneva: WHO.

Fjeld CR, Schoeller DA & Brown KH (1989): A new model for predicting energy requirements of children during catch-up growth developed using doubly labeled water. Pediatr. Res. 25, 503-508.

Fomon SJ, Haschke F. Ziegler EE & Nelson SE (1982): Body composition of reference children from birth to age 10 years. Am. J. Clin. Nutr. 35,1169-1175.

Forsum E, Sadurskis A (1986): Growth, body composition and breast milk intake of Swedish infants during early life. Early Hum. Dev. 14, 121-129.

Heinig MJ, Nommsen LA, Peerson JM, Lönnerdal B & Dewey KG (1993): Energy and protein intakes of breast-fed and formula-fed infants during the first year of life and their association with growth velocity, The Darling Study. Am. J. Clin. Nutr. 58,152-161.

Hendrikson EC, Seacat JM & Neville MC (1985): Insensible weight loss in children under one year of age. Acta Paediatr. Scand. 74, 678-680.

Hoffmans MDAF, Obermann-de Boer GL, Florack KIM, Van Kampen-Donker M & Kromhout D (1986): Energy, nutrient and food intake during infancy and early childhood, The Leiden Pre School Children Study. Hum. Nutr., Appl. Nutr. 40A, 421-430.

Hofvander Y, Hagman U, Hillervik C & Sjölin S (1982): The amount of milk consumed by 1-3 months old breast- or bottle-fed infants. Acta Paediatr. Scand. 71, 953-958.

Horst CH, Obermann-de Boer GL & Kromhout D (1987): Type of milk feeding and nutrient intake during infancy, The Leiden Pre School Children Study. Acta Paediatr. Scand. 76, 865-871.

Jensen CL, Butte NF, Wong WW & Moon JK (1992): Determining energy expenditure in preterm infants, comparison of 2H2 18O method and indirect calorimetry. Am. Physiol. Soc. R685-R692.

Jones PJH, Winthrop AL, Schoeller DA, Swyer PR, Smith J, Filler RM & Heim T (1987): Validation of doubly labeled water for expenditure in infants. Pediatr. Res. 21, 242-246.

Kajtar P, Jéquier E & Prod'hom LS (1976): Heat losses in newborn infants of different body size measured by direct calorimetry in a thermoneutral and a cold environment. Biol. Neonate 38, 55-59.

Köhler L, Meeuwisse G & Mortensson W (1984): Food intake and growth of infants between six and twenty-six weeks of age on breast milk, cow's milk formula, or soy formula. Acta Paediatr. Scand. 73, 40-48.

Leung SSF, Lui S, Lo L & Davies DP (1988): A better guideline on milk requirements for babies below 6 months. Aust. Paediatr. J. 24, 186-190.

Levine SZ, Wilson JR & Kelly M (1929): The insensible perspiration in infancy and in childhood. Amer. J. Disease of Children 37, 791806.

Lucas A, Ewing G, Roberts SB & Coward WA (1987): How much energy does the breast-fed infant consume and expend? Br. Med. J. 295, 75-77.

Martinez GA, Ryan AS & Malec DJ (1985): Nutrient intakes of American infants and children fed cow's milk or infant formula. AJDC 139, 10101018.

McKillop FM & Durnin JVGA (1982): The energy and nutrient intake of a random sample (305) of infants. Hum. Nutr.: Appl. Nutr. 36A, 405-421.

Michaelsen KF, Jørgensen PS, Thomsen BL & Samuelson G (1994): The Copenhagen Cohort Study on Infant Nutrition and Growth: breast-milk intake, human milk macronutrient content, and influencing factors. Am. J. Clin. Nutr. 59, 600-611.

National Center for Health Statistics (1977): NCHS growth curves for children, birth-18 years. DHEW publication No (PHS)78-1650, Washington, DC.

Orr-Ewing A & Heywood PF (1982): Evaporative weight loss estimation in the field. Lancet ii, 617.

Prentice A, Lucas A, Vasquez-Velasquez L. Davies PSW & Whitehead RG (1988): Are current dietary guidelines for young children a prescription for overfeeding? Lancet ii, 1066-1069.

Prentice AM, Coward WA & Vasquez-Velasquez JL (1993): Energy requirements of children: Is growth faltering a consequence of inadequate energy? S. Afr. J. Clin. Nutr. 6, 39-45.

Roberts SB & Coward WA, Schlingenseipen K-H, Nohria V, Lucas A (1986): Comparison of the doubly labeled water (2H2 18O) method with indirect calorimetry and a nutrient-balance study for simultaneous determination of energy expenditure, water intake, and metabolizable energy intake in preterm infants. Am. J. Clin. Nutr. 44, 315-322.

Roberts SB & Young VR (1988): Energy costs of fat and protein deposition in the human infant. Am. J. Clin. Nutr. 48, 951-955.

Roberts SB, Savage J, Coward WA, Chew B & Lucas A (1988): Energy expenditure and intake in infants born to lean and overweight mothers. N. Engl. J. Med. 318, 461-467.

Sauve RS & Geggie JH (1991): Growth and dietary status of preterm and term infants during the first two years of life. Can. J. Pub. Health 82, 95100.

Schofield WN (1985): Predicting basal metabolic rate, new standards and review of previous work. Hum. Nutr.: Clin. Nutr. 39C (Suppl 1): 5-41.

Schutz Y & Decombaz J (1987): Metabolizable energy estimates in infants. J. Pediatr. Gastroenterol. Nutr. 6, 477-478.

Southgate DAT & Barrett IM (1966): The intake and excretion of calorific constituents of milk by babies. Br. J. Nutr. 20, 363-372.

Stuff JE & Nichols BL (1989): Nutrient intake and growth performance of older infants fed human milk. J. Pediatr. 115 959-968.

Stuff JE, Montandon CM, Smith EO & Nichols BL (1991): Between and within-individual variation in formula intake of infants from 12 to 24 weeks of age. Am. J. Clin. Nutr. 51, 525.

Tanner JM (1949): Fallacy of per-weight and per-surface area standards, and their relation to spurious correlation. J. Appl. Physiol. 2, 1-15.

Vasquez-Velasquez L (1988): Energy expenditure and physical activity of malnourished Gambian infants. Proc. Nutr. Soc. 47, 233-239.

Vasquez-Velasquez L (1987): Energy metabolism in children. Ph.D thesis, University of Cambridge.

Watt BK & Merrill AL (1963): Composition of foods. Agricultural Handbook No. 8. Washington, DC: Agricultural Research Service, US Dept of Agriculture.

Westerterp KR, Lafeber HN, Sulkers EJ & Sauer PJJ (1991): Comparison of short term indirect calorimetry and doubly labeled water method for the assessment of energy expenditure in preterm infants. Biol. Neonate 60, 75-82.

Whitehead RG, Paul AA & Cole TJ (1981): A critical analysis of measured food energy intakes during infancy and early childhood in comparison with current international recommendations. J. Hum. Nutr. 35, 339-348.

Wood CS, Isaacs PC, Jensen M & Hilton HG (1988): Exclusively breast-fed infants: growth and caloric intake. Pediatr. Nurs. 14, 177-124.

WHO (1983): Measuring change in nutritional status. Guidelines for assessing the nutritional impact of supplementary feeding programmes for vulnerable groups. Geneva: WHO.


Atwater factors indicate the average amount of energy yielded by one gram of ingested carbohydrate, fat or protein; they are used in the calculation of the metabolizable energy content of foods, for instance in food composition tables and in infant formulas. Atwater (as well as Durnin and Southgate after him) derived them from the heat of combustion, corrected for energy losses in the form of unabsorbed nutrients in feces and urine of adults. The question was raised whether the same factors were also applicable to infants. The answer to this question does not affect energy requirements per se but becomes important in a discussion of recommended dietary intakes. Several factors may influence the metabolizable energy derived from food: (1) the chemical form of the macronutrient in the food, (2) the coefficient of digestibility; (3) the extent to which the nutrients are not completely oxidized, but stored in the body; (4) gut maturation and (5) age. In growing infants nitrogen retention will be higher. Preterm infants absorb less fat than term infants, and fat is generally less well absorbed by newborn infants than by older infants. Fat digestibility is also highly dependent upon the fat source and its processing, e.g. butterfat is poorly absorbed, whereas a mixture of vegetable oils is absorbed nearly to the same extent as human milk. In a study of 10 breast-fed infants fed unpasteurized milk, Southgate found that metabolizable energy averaged 92%. Application of the Atwater factors to human milk components indicated 96% metabolizable energy. Using Atwater factors in normal infants, therefore, does not seem to entail great errors. Application of the Atwater factors in preterm or sick infants may overestimate energy availability.

In young infants the energy content of human milk is of particular importance. Since it is very variable throughout days and feeds and there is no generally agreed upon, standard method for obtaining representative milk samples and for estimating their energy density, published figures vary considerably. Butte et al, using different methods, obtained values between 0.65 and 0.67, whereas values from Sweden (0.72) and a WHO study in Hungary are considerably higher (Waterlow). In the first two figures of her paper, Butte used energy intakes as reported. Dewey pointed out that differences in fat secretion in breast milk between groups of women had been observed, even when exactly the same methods were used. Maternal body fat can affect milk fat (Prentice), as can fat intake in lean women (Dewey). Since pasteurization alters the fat, it is important to note whether pasteurized or non pasteurized milk is used. In the end, the prevailing opinion was that Dewey and Butte had made the most rigorous assessments and that their values should therefore be relied upon primarily.

Several participants were intrigued by the low level of the first two data points in the line representing energy requirements derived from TEE and growth in Butte's figures 7 and 8. Most likely this is an artifact due to an underestimate of the cost of growth in these first two time periods.

Should recommendations be the same or different for breast- and bottle-fed infants? Reeds argued that requirements and intakes should not be confused. Requirements are to be seen as a function of the organism and not of the diet, whereas recommended dietary allowances are a function of the diet and the degree to which it meets requirements. Dewey pointed out that in practice the picture was less clear and the feeding mode seemed to affect physiology. Energy expenditure is lower in breast-fed infants or, in other words, formula-fed infants appear to require more energy than breast-fed ones. These differences are most marked between 3 and 6 months of age; then they gradually disappear, probably as a consequence of the phasing out of pure breast-feeding. Butte tried to derive energy requirements from data of a mixed group of infants, 50% breast- and 50% formula-fed. Dewey advocated separate recommendations for the two feeding groups in order to avoid the :impression that breast-fed infants do not get enough energy and ought to be supplemented or the risk that formula fed infants will not get enough energy to cover their needs. Giving a wide range of requirements does not appear to be a satisfactory solution either.

Butte et al tried to determine how much of a difference in diet-induced thermogenesis (DIT) there was between breast- and formula-fed infants. During the first 4h after the meal, DIT appeared slightly lower in breast-fed infants, but the difference was not statistically significant.

Waterlow queried the validity of 42% for the energetic efficiency of protein synthesis (Table 5, footnote d), and suggested that a figure of 75% would be more in accordance with the evidence.

Do infants growing up in the more stressful environment of developing countries or urban slums have the same or higher energy requirements than infants in industrialized countries? The little information that exists on this issue shows smaller differences than expected. Total energy expenditure (TEE), expressed as kcal/kg, was for instance very similar in infants from The Gambia and the UK (Prentice). Butte compared TEE of small groups (n = 20) of 4-month-old infants from Mexico and Houston. In. Mexico it was 74 kcal/kg, in Houston 64 and 73 kcal/kg for breast- and bottle-fed infants, respectively. Several participants felt that more information was needed to decide the extent to which frequent infections and desirable catch-up growth add to energy requirements in poor environments.

Contents - Previous - Next