1 Protein and energy requirements in healthy and ill paediatric patients

Abstract

A reappraisal of available data, together with new studies, suggests that normal infants' energy and protein requirements might be substantially lower than previously estimated. For example, the safe level of protein intake would amount to only 10 g per day during the first 2 years of life and to about 12 g per day during the third. This has direct consequences for the management of malnourished children, particularly for defining an optimal protein:energy ratio. A reduced food intake has long been accepted as the main cause of malnutrition. However, evidence has accumulated suggesting that metabolic dysregulation may also play a part. This is particularly true for proteins. Net protein deposition in the growing child results from protein synthesis rates being higher than protein breakdown. However, this setting can be disrupted by a significant increase in protein breakdown in response to cytokines. This mechanism, which is found in acute as well as in chronic inflammatory processes, may lead to severe protein malnutrition and is not always amenable to nutritional support.