Activity, Energy Expenditure and Energy Requirements of Infants and Children

Beat Schürch & Nevin S. Scrimshaw, Editors

International Dietary Energy Consultancy Group

Proceedings of an I/D/E/C/G Workshop held in Cambridge, USA

November 14 to 17, 1989

On behalf of the UN ACC-Subcommittee on Nutrition, the International Dietary Energy Consultancy Group (I/D/E/C/G) has been established for the study of dietary energy intake in relation to the health and welfare of individuals and societies by the United Nations University. Its specific objectives are:

1. The compilation and interpretation of research data on functional and other consequences of deficiency, change or excess of dietary energy.

2. The identification of related research needs and priorities, and the promotion of needed research.

3. The publication of scientific and policy statements and other information on the significance of chronic deficiencies and excesses of dietary energy.

4. The identification and promotion of appropriate and practical means of corrective action.

I/D/E/C/G Steering Committee:

- Dr. N.S. Scrimshaw, UNU, Chairman
- Dr. J.G.A.J. Hautvast, IUNS
- Dr. B. Schürch, Executive Secretary

I/D/E/C/G Advisory Group (1989/90)

One-year term:

- Dr. E. Jéquier, Lausanne, Switzerland
- Dr. S. McGregor, Kingston, Jamaica
- Dr. N. Ndolamb, Cotonou, Bénin

Two-year term:

- Dr. G. Beaton, Toronto, Canada
- Dr. A. Ferro-Luzzi, Rome, Italy
- Dr. G. Pelto, Storrs, USA

Three-year term:

- Dr. W.P.T. James, Aberdeen, Scotland
- Dr. E. Pollitt, Davis, USA

- Dr. P.S. Shetty, Bangalore, India

The digitalization of this publication was made possible by a grant from the Nestlé Foundation

Contents

Introduction

Energy requirements in normal infants and children

Abstract
1. Essential terminology and concepts

1.1. Energy requirements
1.2. Recommended dietary allowance (RDA)

2. Factorial approach to energy requirement
3. The breast-fed baby as a model for energy requirements
4. The doubly-labelled water method
5. Application of the doubly-labelled water method to estimate energy requirement
6. Validation studies employing doubly-labelled water

6.1. Energy expenditure and milk intake in fast-growing preterm infants
6.2. Validation of dose-to-the-baby method for measuring milk intake
6.3. Determination of milk energy content using the doubly-labelled water method

7. Metabolisable energy and energy content of breast milk determined by the doubly-labelled water method

7.1. A study and its results
7.2. Critique of findings

8. How logical is the current approach to estimating energy requirements?
9. Future directions
References

Low energy intakes and growth velocities of breast-fed infants: Are there functional consequences?

Abstract
1. Introduction
2. Methods

2.1. Study design
2.2. Anthropometry
2.3. Morbidity
2.4. Energy intake
2.5. Activity
2.6. Data analysis

3. Results
4. Conclusions
Acknowledgements
References
Discussion (summarized by A.M. Prentice)

Methods to assess physical activity and the energy expended for it by infants and children

Abstract
1. General considerations in deciding what to measure
2. Methods of acquiring information on the physical activity of infants and children

2.1. Questionnaire or diary record
2.2. Direct, objective measurements of activity
2.3. Heart-rate recording
2.4. Methods of acquiring information on energy expenditure

3. Conclusions
References

Estimation and validation of energy expenditure obtained by the minute-by-minute measurement of heart-rate

Abstract
1. Heart-rate method

1.1. Subject calibration
1.2. Calculation of energy expenditure from fH

2. Validation of heart-rate method

2.1. Sources of error

3. Applications of the heart-rate method

3.1. Daily pattern of EE and TDEE
3.2. Pattern of relative effort
3.3. Comparison of EE pattern of individuals

Acknowledgements
References

Assessment and significance of body composition in infants and children

Abstract
1. Techniques for estimating body composition
2. Changes in body composition during growth
3. The companionship of lean body mass and fat
4. Maintenance energy need is related to body size and composition
5. The energy cost of weight gain
Acknowledgements
References
Discussion (summarized by A. Ferro-Luzzi)

Total energy expenditure of free-living infants and children obtained by the doubly-labelled water method

Abstract
1. Introduction
2. Method

2.1. Principle of the doubly-labelled water method
2.2. Validation studies
2.3. Possible sources of error in field applications

3. A review of published studies

3.1. Studies in hospitalised patients
3.2. Studies in free-living, but sick, children
3.3. Studies relating to obesity
3.4. Studies in breast-fed and formula-fed infants
3.5. Studies in undernourished children
3.6. Using DLW estimates to establish energy requirements

4. Outstanding methodological concerns
5. Future studies
6. Conclusions
References

Reference data for total energy expenditure in early infancy

Abstract
1. Introduction
2. Methods

2.1. Relationship between body weight and energy expenditure
2.2. Calculations of centiles

3. Results

3.1. Relationship between total energy expenditure and body weight
3.2. Construction of centiles

4. Discussion
References
Discussion summarized by J.V.G.A. Durnin

Basal metabolism of infants

Abstract
1. Historical work
2. Basal metabolism defined
3. Factors which may influence basal metabolism
4. Normative standards
Acknowledgments
References
Discussion (summarized by B. Schürch)

Energy cost of various physical activities in healthy children

Abstract
1. Introduction
2. Methodological considerations

2.1. Age and sex
2.2. Number of children and measurements
2.3. Weight, BMR and energy costs
2.4. Social, nutritional, national and ethnic characteristics
2.5. Description of activities
2.6. Calculations and assumptions

3. Results
4. Discussion

4.1. Information gaps
4.2. Geographic or racial differences
4.3. Energy costs in relation to age and sex
4.4. Suggestions to estimate the energy cost of activities

References
Discussion (summarized by B. Schürch)

The energy requirements of growth and catch-up growth

Abstract
1. General concept of growth
2. Outcome variables

2.1. Height
2.2. Biochemical and functional tests
2.3. Weight and nitrogen balance

3. General principles relating nutrients to growth
4. Hierarchy of metabolic functions
5. Normal growth
6. Catch-up growth

6.1. Nutritional determinants of catch-up growth
6.2. Use of weight/increment in body fat
6.3. Body composition during catch-up growth

7. Factors affecting net energy accretion

7.1. Limiting specific nutrient
7.2. Effect of protein: Quantity and quality
7.3. Theoretical model for P:E ratio

8. Extent to which colonic fermentation of carbohydrates contributes to energy requirements in childhood

8.1. Colonic fermentation
8.2. Energy from SCFA
8.3. Factors influencing SCFA production
8.4. Gross versus metabolizable energy
8.5. Faecal energy and non-starch polysaccharide
8.6. Faecal energy in cystic fibrosis

9. Conclusions
Acknowledgements
References

Energy cost of communicable diseases in infancy and childhood

Abstract
1. Introduction
2. Variation in morbidity from infectious disease
3. Effects of infection on energy status

3.1. Anorexia
3.2. Decreased dietary thermogenesis
3.3. Cultural and therapeutic practices
3.4. Malabsorption
3.5. Metabolic effects
3.6. Fever
3.7. Additional intestinal loss
3.8. Anabolic responses during infection
3.9. Reduced growth and weight loss

4. Reduced activity
5. Energy requirements for recovery from infection
6. Anabolic response
References
Discussion (summarized by B. Schürch)

Energy-sparing mechanisms: reductions in body mass, BMR and activity: their relative importance and priority in undernourished infants and children

Abstract
1. Introduction
2. Physical activity
3. Basal metabolic rate and body composition
4. Sequence of events during recovery
6. Future research
References
Discussion (summarized by A.M. Prentice)

The desirable upper limits of energy intake in childhood: Short- and long-term consequences

Abstract
1. Introduction
2. A conceptual approach to defining desirable intakes in infancy
3. Childhood obesity and energy intake
4. Individual susceptibility to obesity
5. Desirable intakes in infancy

5.1. Lower intakes on modern formulae
5.2. Differences in intake of bottle-fed and breast-fed children
5.3. Secular changes in intake of the breast-fed child

6. Ambient temperature and diet-induced thermogenesis
7. Should energy requirements be based on data for breast-fed children?
8. The fat cell hypothesis
9. The Dutch famine study: An early programming of adiposity?
10. Links between childhood and adult obesity
11. Experimental findings
12. The effects of early feeding practices on the programming of metabolism
13. Infant growth rates and long-term survival
14. Conclusions
References
Discussion (summarized by W. Dietz)

Long-term developmental implications of motor maturation and physical activity in infancy in a nutritionally at risk population

Abstract
1. Background
2. A theoretical formulation
3. Purpose
4. Methods

4.1. Subjects
4.2. Variables and measurements

5. Results
6. Discussion
References
Discussion (summarized by C.M. Super)

Temperament, activity and behavioral development of infants and children

Abstract
1. The concept of temperament
2. Activity level as a dimension of temperament
3. The behavioral assessment of activity level
4. The role of activity in studies of energy expenditure/energy requirements
5. Activity level and information processing
6. Activity level and the influence of the child's psychosocial environment
7. Conclusions
Acknowledgements
References

The cultural regulation of infant and child activities

Abstract
1. Research on culture and child development
2. The developmental niche
3. The regulation of infant state
4. The activities of older infants and children
5. Toward a typology of activities
References

Short- and long-term effects of low or restricted energy intakes on the activity of infants and children

Abstract
1. Introduction
2. Infants and children under two years of age
3. Preschool children

3.1. Short-term study in a clinical setting
3.2. Longer-term study in a clinical setting
3.3. Community-based studies

4. School-age children
5. Short- and long-term effects

5.1. Adaptation and accomodation
5.2. Reduction in energy expenditure
5.3. Behavior and social performance
5.4. Low physical activity and growth
5.5. Reduction in physical fitness

6. Conclusions
Acknowledgements
References
Discussion (summarized by N. Solomons)

The relationship between undernutrition, activity levels and development in young children

Abstract
1. Functional isolation
2. Definition of malnutrition
3. Severe undernutrition

3.1. Developmental levels in the acute stage
3.2. Behavior
3.3. Relationship between development, activity and exploration
3.4. Relationship between development and anthropometry
3.5. Children after recovery from the acute episode
3.6. Jamaican study
3.7. Conclusions

4. Mild-to-moderate undernutrition

4.1. Development and anthropometry
4.2. Development and nutritional supplementation
4.3. Activity and exploration
4.4. Studies with development and behavioral measures
4.5. Nutritional supplementation and behavior
4.6. Summary

5. Preliminary findings from a study of nutritional supplementation and psychosocial stimulation of stunted children

5.1. Developmental levels
5.2. Activity levels
5.3. Relationship between activity and development
5.4. Dietary intakes
5.5. Conclusions

Acknowledgements
References
Discussion (summarized by B. Torun)

Indicators for the extent to which energy requirements are being met in infants and children

Implications of new knowledge for recommendations of energy intakes

Implications of new knowledge for the prevention and treatment of PEM in infants and children

Implications of new knowledge for the prevention and treatment of obesity in infants and children

Needs and priorities for research and action from the physiological point of view

Needs and priorities for research and action from the behavioral point of view

Needs and priorities for research and action from the point of view of policy

List of participants