Dietary Protein Intake in Young Children in Selected Low-Income Countries Is Generally Adequate in Relation to Estimated Requirements for Healthy Children, Except When Complementary Food Intake Is Low

Joanne E Arsenault,Kenneth H Brown

doi:10.3945/jn.116.239657

Joanne E Arsenault, Kenneth H Brown

Open Access

https://doi.org/10.3945/jn.116.239657

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Abstract

Background Previous research indicates that young children in low-income countries (LICs) generally consume greater amounts of protein than published estimates of protein requirements, but this research did not account for protein quality based on the mix of amino acids and the digestibility of ingested protein.Objective: Our objective was to estimate the prevalence of inadequate protein and amino acid intake by young children in LICs, accounting for protein quality.Methods: Seven data sets with information on dietary intake for children (6–35 mo of age) from 6 LICs (Peru, Guatemala, Ecuador, Bangladesh, Uganda, and Zambia) were reanalyzed to estimate protein and amino acid intake and assess adequacy. The protein digestibility–corrected amino acid score of each child's diet was calculated and multiplied by the original (crude) protein intake to obtain an estimate of available protein intake. Distributions of usual intake were obtained to estimate the prevalence of inadequate protein and amino acid intake for each cohort according to Estimated Average Requirements.Results The prevalence of inadequate protein intake was highest in breastfeeding children aged 6–8 mo: 24% of Bangladeshi and 16% of Peruvian children. With the exception of Bangladesh, the prevalence of inadequate available protein intake decreased by age 9–12 mo and was very low in all sites (0–2%) after 12 mo of age. Inadequate protein intake in children <12 mo of age was due primarily to low energy intake from complementary foods, not inadequate protein density.Conclusions Overall, most children consumed protein amounts greater than requirements, except for the younger breastfeeding children, who were consuming low amounts of complementary foods. These findings reinforce previous evidence that dietary protein is not generally limiting for children in LICs compared with estimated requirements for healthy children, even after accounting for protein quality. However, unmeasured effects of infection and intestinal dysfunction on the children's protein requirements could modify this conclusion.

Highlights

Previous research indicates that infants and young children in low-income countries (LICs)[6] generally consume greater amounts of protein from complementary foods than published estimates of protein requirements, assuming average amounts of breast milk consumption (1–3)
Previous assessments did not account for protein quality, which incorporates information on the specific mix of amino acids in complementary foods and breast milk and the digestibility of ingested protein, and did not use currently accepted methods for assessing total nutrient intake adequacy of populations, based on usual intake distributions after adjusting for within-individual variation (4)
Some of the original studies included a specific cutoff for length-for-age z score (LAZ) as a criterion for selection into the study; children in the Peru study had an initial LAZ less than 20.5, and children in the Ecuador study had an LAZ less than 21.25 compared with reference data available at the time of these studies

Summary

Introduction

Previous research indicates that infants and young children in low-income countries (LICs)[6] generally consume greater amounts of protein from complementary foods than published estimates of protein requirements, assuming average amounts of breast milk consumption (1–3). Previous research indicates that young children in low-income countries (LICs) generally consume greater amounts of protein than published estimates of protein requirements, but this research did not account for protein quality based on the mix of amino acids and the digestibility of ingested protein. Conclusions: Overall, most children consumed protein amounts greater than requirements, except for the younger breastfeeding children, who were consuming low amounts of complementary foods These findings reinforce previous evidence that dietary protein is not generally limiting for children in LICs compared with estimated requirements for healthy children, even after accounting for protein quality.

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