CALORIE DEFICIENCY IN CHILDREN WITH UREMIA: EFFECT UPON GROWTH

Abstract

Appetite failure leading to caloric deficiency is a factor in the poor growth of children with chronic renal disease. Management of these children on chronic hemodialysis has afforded an opportunity to examine the consequences of caloric deficiency, the role of appetite, and the value of supplying extra calories to improve growth. The choice of caloric deficiency in uremia as the subject for the first William Wallace Lecture is fitting because of William Wallace's lifelong interest in nutrition and growth. Dr. Wallace had an ability to examine old problems and dogmas from new perspectives and provoked his associates to join him in these inquiries; his paper on "Why and How are Children Fat?" raised questions about the physiological and emotional factors which might cause children to eat in excess of calorie expenditure and become too fat. The opposite problem, malnutrition or caloric deficiency, is presented by children with renal failure. In this lecture I would like to review the energy requirements of normal children during growth, the factors which can limit food intake and lead to caloric deficiency in sickness, and the special reasons why children with uremia are more prone to develop calorie deficiency than adults. The term calorie balance or expenditure is used rather than energy balance or expenditure because the amount of calorie intake is the critical factor I wish to examine. CALORIE REQUIREMENTS AND THE CONSEQUENCES OF CALORIE DEFICIENCY An understanding of the normal relation of calorie expenditure to body size and composition as growth proceeds is a prerequisite to a consideration of the greater susceptibility of children with uremia to calorie deficiency.