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Recommendations


The 1985 FAO/WHO/UNU recommendations for dietary energy intake of healthy infants seem too high based on reported measurements of energy intake or energy expenditure and estimates of the energy deposited for growth. Because observed energy intakes may not reflect desirable intakes, measurements of energy expenditure are preferred as the basis for estimating energy requirements. Estimated energy requirements of infants based on total energy expenditure and growth are 9-39% lower than the 1985 FAO/WHO/UNU recommendations and provide strong evidence that current estimates should be revised. However, confirmation of this observation will require expansion of the available database on total energy expenditure of healthy infants, in terms of sample size, age range and geographic distribution across the entire age range of infancy. Data are particularly scarce in the second 6 months of infancy. Estimated energy requirements should be consistent with the growth reference endorsed by WHO. To better define the energy deposited during growth, changes in body composition during infancy must be confirmed.

Given the relative uniformity of behavior, physical activity and growth of healthy infants from different geographic origins, estimates of energy requirements can be applied universally to healthy infants. It should be appreciated that energy requirements of infants are a function of age, gender, body size and feeding mode. Stipulation of estimated energy requirements by these factors will depend on the application.

More data must be sought on the energy expenditure of infants in populations at risk of high rates of infection and exposed to other environmental sources of stress to determine if energy requirements are altered under these circumstances. The energy needs for adequate catch-up growth also must be considered.

Table 6 Energy requirement estimated from total energy expenditure and energy cost of growth


Age
(months)

Total energy expenditure

Energy deposition

ALL
(kcal/d)

BFa
(kcal/d)

FFa
(kcal/d)

ALL
(kcal/d)

BFa
(kcal/d)

FFa
(kcal/d)

(kcal/d)

(kcal/kg/d)

Boys

0-1

248

228

268

65

61

68

113

26

1-2

320

300

340

67

64

70

113

26

2-3

389

368

409

70

67

73

136

24

3-4

454

434

474

72

69

76

90

14

4-5

516

495

536

75

72

78

62

9

5-6

574

553

594

78

74

81

49

6

6-9

684

664

705

83

80

86

28

3

9-12

843

822

863

91

87

94

19

2

Girls:

0-1

241

220

261

65

61

68

102

22.5

1-2

306

286

326

67

64

70

102

22.5

2-3

369

349

389

70

67

73

108

20

3-4

431

411

451

72

69

76

79

13

4-5

492

472

513

75

72

78

65

10

5-6

552

532

573

78

74

81

56

8

6-9

666

645

686

83

80

86

26

3

9-12

820

799

840

91

87

94

21

2

Energy requirement

Age
(months)

BFa
(kcal/d)

FFa
(kcal/d)

ALL
(kcal/kg/d)

BFa
(kcal/kg/d)

FFa
(kcal/kg/d)

Boys

0-1

341

381

91

87

94

1-2

413

453

93

90

96

2-3

504

545

94

91

97

3-4

524

564

86

83

90

4-5

557

598

84

81

87

5-6

602

643

84

80

87

6-9

692

733

86

83

89

9-12

841

882

93

89

96

Girls:

0-1

322

363

88

84

90

1-2

388

428

90

86

92

2-3

457

497

90

87

93

3-4

490

530

85

82

89

4-5

537

578

85

82

88

5-6

588

629

86

82

89

6-9

671

712

86

83

89

9-12

820

861

93

89

96

a BF = breast-fed; FF = formula-fed infants.

FIGURE 6 Energy requirements if infants estimated from total energy expenditure and energy deposition (kcal/kg/d).

FIGURE 7 FAO/WHO/UNU energy requirements compared against requirements (1) based on energy intakes observed after 1980 and (2) total energy expenditure (TEE) and energy deposition during growth (kcal/d).

FIGURE 8 FAO/WHO/UNU energy requirements compared against requirements (1) based on energy intakes observed after 1980 and (2) total energy expenditure (TEE) and energy deposition during growth (kcal/kg/d).

Acknowledgements - I wish to thank Drs PSW Davies, Cambridge, UK; KG Dewey, University of California-Davis; KF Michaelsen, The Royal Veterinary and Agricultural University, Copenhagen,
Denmark; AM Prentice, Dunn Nutrition, Cambridge, UK; AS Ryan, Ross Laboratories, Columbus, Ohio, and JE Stuff, Children's Nutrition Research Center, Houston, Texas for their contribution of data used in this manuscript, as well as Dr C Garza, Cornell University, Ithaca, New York, for his thoughtful review. I would also like to thank I Tapper for manuscript preparation, and L Loddeke and R Klein for editorial review.

This work is a publication of the USDA/ARS Children's Nutrition Research Center, Department of Pediatrics Baylor College of Medicine and Texas Children's Hospital, Houston, TX. Funding has been provided from the U.S. Department of Agriculture, Agricultural Research Service under Cooperative Agreement No. 58-6250-1-003. The contents of this publication do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.


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