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close this bookProtein-Energy Requirements of Developing Countries: Evaluation of New Data (UNU, 1981, 268 p.)
close this folderProtein-energy requirements-children
close this folderRecommended dietary energy intakes for the first six months of life
View the document(introduction...)
View the documentObjective
View the documentExperimental details
View the documentSummary of main results
View the documentConclusions and comments

(introduction...)

Objective
Experimental details
Summary of main results
Conclusions and comments

R.G. Whitehead, A.A. Paul, A.E. Black, and S.J. Wiles
Medical Research Council Dunn Nutrition Unit, Cambridge, England

Objective

To obtain more precise knowledge of the energy requirements of young babies, which is essential for the planning of rational infant-feeding strategies.

Experimental details

1. Subjects
Twenty infants were studied (13 male and 7 female), as part of a longitudinal investi gation on maternal nutrition and lactation. All were breast-fed up to the sixth month, and 16 were still being breast-fed by the end of the seventh month. Fifteen of the mothers were recruited through the Cambridge Maternity Hospital, and five via the National Childbirth Trust.

2. Anthropometry
The babies' weights, lengths (using a Harpenden Infant Measuring Table), and triceps skin-fold thicknesses (using Holtain callipers) were measured at monthly intervals.

3. Dietary Intakes
From four weeks of age, breast-milk intakes were measured in the home on four consecutive days each month by test-weighing, using Salter Baby weigher Model 40 Scales, after the mothers had received careful instruction in this technique. All other food and drink, including medicaments such as gripe water and "vitamin syrups," were also quantitatively recorded by the mothers for the same four days. First, supplementary foods introduced were usually proprietary cereal preparations, "baby dinners," or foods from the rest of the family's supply; infant formulas based on cow's milk were never given. Energy intakes were calculated using food composition tables and from information provided by manufacturers. The energy content of breast milk was taken to be 69 kcal/100 9, the average value found in a recent national survey of British mothers'milk.



FIG. 1. Total Energy Intake of 20 Babies Compared with the Recommendations of WHO/FAD and the United Kingdom's DHSS (Values are mean + S.E.M.)

Summary of main results

1. Figure 1 shows that after two months total energy intakes were substantially below FAD/WHO recommendations for the average child and there was little difference whether the children were wholly or partially breast-fed. After two to three months there was almost no further rise in intake, although between then and the seventh month the children increased in weight by a further 43 per cent.

2. Body weight ranged within about 3 kg at any given age, as shown in table 1. The total energy intake of individual babies depended mainly on how heavy they were, but it became more consistent when adjusted for body weight.

3 Figure 2 shows the infants' anthropometric data compared with the Tanner-Whitehouse standards for British babies. The biggest difference between the measurements made and the standard was in triceps skin-fold thickness, which suggests that one consequence of the lower energy intakes might be a reduction in body-fat stores.

Conclusions and comments

1. Total energy intakes of both fully breast-fed and mixed-fed infants were considerably below the internationally recommended levels. They were, however, identical with energy intakes calculated from recent Swedish studies on breast-fed children and with those from the much earlier and classical investigations of Wallgren (Acta Paediat Scand., 32: 778, [1944-1945] ).

TABLE 1. Energy Intakes Adjusted for Body Weight in Breast-fed Babies (values are means + S.D.)

Mean age (months) No. Weight (kg) Energy intake/kg body wt. (kcals)
1.26 20 4.42 0.63 115 18
2.31 20 5.42 0.73 101 13
3.41 20 6.17 0.83 90 12
4.49 20 6.80 0.86 86 14
5.62 20 7.35 0.87 85 13
6.66 16 7.75 0.81 84 12



FIG. 2. Weight, Triceps Skin-fold, and Length of 20 Breast-fed Babies Compared with Tanner Whitehouse Standards. For weight and length, the standards represented are the 75th, 50th, and 25th centiles; for triceps skin-folds, the 50th, 25th, and 10th.

2. Initial growth was good, but after about three months the lower average intakes began to be associated with a general deviation away from the Tanner-Whitehouse growth standards. However, these standards are higher than other standards.

3. From the present data, it would seem reasonable to conclude that the present FAD/WHO recommended energy intakes for young infants are too high. Up to three months of age, the recent UK Department of Health and Social Security (DHSS) values probably represent a more realistic estimate of the true needs of the average child. Whether even the DHSS recommendations are excessive from then onward depends on the interpretation placed on the anthropometric findings and the standards used.

4. A very careful and long-term evaluation would be required to decide whether deviations in growth of the magnitude found really did reflect processes disadvantageous to the child. The safer conclusion is the DHSS recommendation that dietary energy intake should remain at 100 kcal/kg after three months of age and throughout the rest of infancy.

Acknowledgements

We thank the mothers for their co-operation in this study, Mrs. J. Evans for the anthropometric measurements, Miss J.J. Whichelow for the recruitment of the mothers, and Dr. N.R.C. Roberton and the staff at the Cambridge Maternity Hospital. The study was financially supported by the Department of Health and Social Security.