Infant Intake Research Articles

Dietary Intake and Nutritional Status in Infants From the Urban Slums of Mumbai, India

ObjectiveThis study was conducted to assess dietary intake and nutritional status of infants living in the urban slums of Mumbai, India, in preparation for a randomized efficacy feeding trial of iron‐biofortified pearl millet.MethodsStudy participants (n=37) were infants aged six to 12 months from the slums of Mumbai. Infant dietary intake was assessed by 24‐hour dietary recall, administered to mothers; nutrient intake was calculated using CS dietary software. Anthropometric measurements of infant length and weight were recorded. World Health Organization (WHO) z‐scores for weight‐for‐age (WAZ), length‐for‐age (LAZ), and weight‐for‐length (WLZ) were calculated, and used to define underweight (WAZ<−2), stunting (HAZ<−2), and wasting (WLZ<−2).ResultsIn this study, infants did not meet the Indian recommended dietary allowances (RDA) for energy (78%), fat (86%), and calcium (67%). Dietary intake of iron was 35% of the Indian RDA. The protein intake was above the Indian RDA (>100%). Mean WAZ, LAZ, and WLZ scores were −1.3 (SD: 0.8), −1.8 (SD: 1.0), and −0.5 (SD: 0.8) respectively, and 37% of infants were stunted.ConclusionsDietary intake of iron, calcium, fat, and total energy were low in this population, and more than one–third of infants were stunted. Effective and sustainable nutritional interventions are urgently needed to improve the dietary and nutritional status of infants living in this setting.Support or Funding InformationSupported by HarvestPlus/IFPRI

Optimising preterm nutrition: present and future.

The goal of preterm nutrition in achieving growth and body composition approximating that of the fetus of the same postmenstrual age is difficult to achieve. Current nutrition recommendations depend largely on expert opinion, due to lack of evidence, and are primarily birth weight based, with no consideration given to gestational age and/or need for catch-up growth. Assessment of growth is based predominately on anthropometry, which gives insufficient attention to the quality of growth. The present paper provides a review of the current literature on the nutritional management and assessment of growth in preterm infants. It explores several approaches that may be required to optimise nutrient intakes in preterm infants, such as personalising nutritional support, collection of nutrient intake data in real-time, and measurement of body composition. In clinical practice, the response to inappropriate nutrient intakes is delayed as the effects of under- or overnutrition are not immediate, and there is limited nutritional feedback at the cot-side. The accurate and non-invasive measurement of infant body composition, assessed by means of air displacement plethysmography, has been shown to be useful in assessing quality of growth. The development and implementation of personalised, responsive nutritional management of preterm infants, utilising real-time nutrient intake data collection, with ongoing nutritional assessments that include measurement of body composition is required to help meet the individual needs of preterm infants.

ASUPAN ZAT BESI DAN SENG PADA BAYI UMUR 6 – 11 BULAN DI KELURAHAN JATI CEMPAKA, KOTA BEKASI, TAHUN 2014

Infants are at higher risk of iron and zinc deficiency because of their rapid growth and higher iron and zinc needs. The infants’ iron and zinc status are directly affected by their dietary intake. The aims of this study were to measure the average and the deficit of iron and zinc intake in infants aged 6 – 11.months in Kelurahan Jati Cempaka Kota Bekasi, 2014. The research was conducted in 10 Integrated Health Service in Kelurahan Jati Cempaka, Bekasi City, 2014. Eighty pairs of infants and mothers were selected as samples. Infants’ intake were assessed by 2 x 24 hours non-consecutive dietary recall. Independent T test analysis were conducted to identify the differences in iron and zinc intake between underweight infant and infant with normal nutritional status. Analysis showed that iron and zinc the total of average of breastfeeding infants were 2,3 ± 1,2 mg/day and 1,7 ± 0,7 mg/day. Iron and zinc The average deficit of of breastfeeding infants were 4,7 ± 1,2 mg/day and 1,3 ± 0,7 mg/day. There was significant difference on the average of iron intake between underweight infant and infants with normal nutritional status. But there was no significant difference on the zinc intake. However zinc intake the average of of underweight infant was lower than the normal infant with normal nutritional status. Nutrition counseling about good complementary feeding practice to the mothers of infants is needed, especially complementary food from animal source. Multi micro nutrient supplementations to the infants need to be considered, regarding low consumption of complementary food from animal source.

Nutritional Intake, Energy Expenditure, and Growth of Infants Following Congenital Diaphragmatic Hernia Repair.

The pathophysiology of failure to thrive in congenital diaphragmatic hernia (CDH) has not been fully elucidated, and the nutritional care of these infants is hindered by paucity of data on the optimal calorie requirements for growth. The primary objective of this study was to investigate the energy intake required for infants with CDH to grow optimally at the time of first hospital discharge. The secondary objectives were to assess their measured resting energy expenditure in infancy, and their long-term growth outcomes. Nutritional intake, anthropometrics, indirect calorimetry results, and respiratory status of infants with CDH from 2011 to 2014 were collected retrospectively. Data on confounders (gastroesophageal reflux disease and feeding intolerance, respiratory rate and pulmonary hypertension) were also collected. Analyses were performed using Stata (College Station, TX). Of the 72 infants diagnosed with CDH during that period of time, 43 met the inclusion criteria. A caloric intake of 125.0 ± 20 kcal · kg · day was required to meet discharge weight gain criteria (25-35 g · kg · day). In a subset of 17 patients, measured resting energy expenditure was higher than predicted resting energy expenditure (58.0 ± 18 vs 46.6 ± 3 kcal · kg · day, P < 0.05), and 59% of infants were hypermetabolic (measured resting energy expenditure >110% of predicted resting energy expenditure) in early infancy. Failure to thrive prevalence at discharge was 16.2% compared to 3.6% and 4.2% at 12- and 24-months of age, respectively (P = 0.03; P = 0.005, respectively). Optimal weight gain can be achieved with higher than predicted calorie provision. Most infants with CDH are hypermetabolic. Despite this, failure to thrive prevalence can improve during the first year of life.

Protein intake in early childhood and body composition at the age of 6 years: The Generation R Study.

Previous studies suggest that high protein intake in infancy leads to a higher body mass index (BMI) in later childhood. We examined the associations of total, animal and vegetable protein intake in early childhood with detailed measures of body composition at the age of 6 years. This study was performed in 2911 children participating in a population-based cohort study. Protein intake at the age of 1 year was assessed with a validated food-frequency questionnaire and was adjusted for total energy intake. At the children's age of 6 years, we measured their anthropometrics and body fat (with dual-energy X-ray absorptiometry). We calculated age- and sex-specific s.d. scores for BMI, fat mass index (FMI) and fat-free mass index (FFMI). After adjustment for confounders, a 10 g per day higher total protein intake at 1 year of age was associated with a 0.05 s.d. (95% confidence interval (CI) 0.00, 0.09) higher BMI at age 6. This association was fully driven by a higher FMI (0.06 s.d. (95%CI 0.01, 0.11)) and not FFMI (-0.01 s.d. (95%CI -0.06, 0.05)). The associations of protein intake with FMI at 6 years remained significant after adjustment for BMI at the age of 1 year. Additional analyses showed that the associations of protein intake with FMI were stronger in girls than in boys (P for interaction=0.03), stronger among children who had catch-up growth in the first year of life (P for interaction<0.01) and stronger for intake of animal protein (both dairy and non-dairy protein) than protein from vegetable sources. Our results suggest that high protein intake in early childhood is associated with higher body fat mass, but not fat-free mass. Future studies are needed to investigate whether these changes persist into adulthood and to examine the optimal range of protein intake for infants and young children.

住宅における空気・ハウスダスト中SVOC濃度測定

In recent years, indoor air pollution due to phthalate esters has gained increasing attention. In particular, phthalate esters present in house dust have been reported to have a considerable impact on infant health. This study was investigated the concentration of phthalate esters in indoor air and house dusts in residential houses (n=21). Collected indoor air and house dust were analyzed for 11 substances. As a result, phthalate esters concentrations in indoor air were 0.7～29.3μg/m3 for 2E1H, 0.1～2.0μg/m3 for D6, 0.1～0.9μg/m3 for DBP and 0.1～1.2μg/m3 for DEHP. The concentrations of DEP, TBP, D6, BHT and DBA in house dust were less than detection limit. But, these were detected for TCEP (20～40μg/g), DOA (2～70μg/g), DBP (15～200), DEHP (50P:810(μg/g), 95P:4660(μg/g)). Assuming that an infant intakes 10.3 mg/kg/day of house dust in 95 percentile, infants would intake 47.9μg/kg/day DEHP which exceeds the guidelines for tolerable daily intake (TDI) and reference dose (RfD).

Amino Acid Intake in Preterm Infants.

A large proportion of extremely low-birth-weight infants requires parenteral nutrition for variable lengths of time. Amino acids are the key ingredients of parenteral nutrition. The goal of appropriate amino acid administration is to promote anabolism and normal cellular development in order to limit the incidence of postnatal growth restriction, which is associated with neurodevelopmental delays. The benefits of early amino acid commencement soon after birth are compelling, especially on nitrogen balance, while long-term outcome studies are lacking. Amino acid administration at 2.5 g/kg per day has been shown to be superior to lower intakes; however, the benefits of intakes above 2.5 g/kg per day remain controversial.

Food groups consumed by infants and toddlers in urban areas of China

BackgroundFood consumption patterns of young children in China are not well known.ObjectiveCharacterised food groups consumed by infants and young children in urban China using data from the Maternal Infant Nutrition Growth (MING) study.DesignOne 24-h dietary recall was completed for 1,350 infants and young children (436 infants aged 6–11 months and 914 young children aged 12–35 months), who were recruited from maternal and child care centres in eight cities via face-to-face interviews with the primary caregiver. All foods, beverages and supplements reported were assigned to one of 64 food groups categorised into the following: milk and milk products, grains, vegetables, fruits, protein foods and desserts/sweets. The percentage of infants and young children consuming foods from specific food groups was calculated, regardless of the amount consumed.ResultsLess than half of infants consumed breast milk (47%), whereas 59% of infants consumed infant formula and 53–75% of young children consumed growing-up (fortified) milk. Rice was the number one grain food consumed after 6 months (up to 88%) and the consumption of infant cereal was low. About 50% of infants did not consume any fruits or vegetables, and 38% of young children did not consume any fruits on the day of the recall. Only 40% of all children consumed dark green leafy vegetables and even fewer consumed deep yellow vegetables. Eggs and pork were the most commonly consumed protein foods.ConclusionsThe data provide important insight for developing detailed food consumption guidelines for this population group. Mothers of infants should be encouraged to continue breastfeeding after the first 6 months. Parents should be advised to offer a wide variety of vegetables and fruits daily, particularly dark green leafy and deep yellow vegetables and colourful fruits. The consumption of fortified infant cereal should be advocated to improve the iron intake of Chinese infants.

Relationship between beverage intake of infants and their mother’s awareness on beverage

Relationship between beverage intake of infants and their mother’s awareness on beverage

Resting energy expenditure, macronutrient utilization, and body composition in term infants after corrective surgery of major congenital anomalies: A case-study.

Knowledge on the metabolic changes and nutritional needs during the postsurgical anabolic phase in infants is scarce. This analysis explores the associations of resting energy expenditure (REE) and macronutrient utilization with body composition of full-term infants, during catch-up growth after corrective surgery of major congenital anomalies. A cohort of full-term appropriate for-gestational-age neonates subjected to corrective surgery of major congenital anomalies were recruited after gaining weight for at least one week. REE and macronutrient utilization, measured by respiratory quotient (RQ), were assessed by indirect calorimetry using the Deltatrac II Metabolic Monitor®. Body composition, expressed as fat-free mass (FFM), fat mass (FM) and adiposity defined as percentage of FM (% FM), was measured by air displacement plethysmography using the Pea Pod®. Four infants were included at 3 to 5 postnatal weeks. Recommended energy and macronutrient intakes for healthy term infants were provided. Through the study, the median (min-max) REE (Kcal/Kg FFM/d) was 70.8 (60.6-96.1) and RQ was 0.99 (0.72-1.20). Steady increases in both body weight and FFM were associated with initial decrease in FM and adiposity followed by their increase. Low RQ preceded decrease in adiposity. The marked adiposity depletion, not expected during steady weight gain in the postsurgical period, prompts us to report this finding. The subsequent adiposity catch-up was associated with relatively high REE and RQ, suggesting preferential oxidation of carbohydrates and preservation of lipids for fat storage.

Long-Chain Polyunsaturated Fatty Acid Concentrations in Breast Milk from Chinese Mothers: Comparison with Other Regions

Long-chain polyunsaturated fatty acids (LC-PUFA), especially linoleic acid (LA), arachidonic acid (AA), alpha- linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are essential to infant growth and development during early life. Up till now, there is only limited number of studies with large sample size on LC-PUFA in breast milk in China. In order to better understand the LC-PUFA levels in Chinese women, we report an analysis that included 44 studies of 3815 subjects from the latest 10-year peer-reviewed papers of breast milk studies of fatty acid profiles from China and other regions: Asia (excluding China), Europe, America and Africa. The results showed that Chinese women had significantly higher LA and ALA levels in the breast milk than European and other Asian women. The DHA level in the breast milk of Chinese women meets the Chinese and international recommended intake for young infants. This review provides comprehensive investigation on the LC-PUFA levels in the mature milk of Chinese women in most recent publications and server as a reference for further studies on human milk in China.

Nutritional composition of infant milk formulas. Level of compliance in their manufacture and adequacy of nutritional needs

Abstract Introduction A high percentage of infants are fed with infant formulas. The aim of this study was to assess compliance with Technical Sanitary Regulations on the manufacture of Spanish infant formulas, and analyse their compliance with recommendations relating to nutritional composition and the Dietary Reference Intakes for infants. Materials and methods A total of 31 formulas were analysed, of which 18 were infant formulas, 10 follow-on formulas, and 3 growing-up milks. The European Technical Sanitary Regulations, the Spanish Dietary Reference Intakes and the Institute of Medicine of the United States and Canada were used for the assessment of compliance and adequacy. Results The energy and macronutrient content of analysed infant formulas is placed in the middle of the range indicated in the Technical Sanitary Regulations, and meets the recommended amounts. However, most micronutrients such as phosphorus, calcium, retinol, vitamins D, E, C, B6, B12, thiamin, riboflavin, and folate are at the lower limit of the Technical Sanitary Regulations. However, the recommended consumption of infant formulas exceeded the Dietary Reference Intakes for vitamins E, C, retinol, vitamin B and folate, and vitamin B12 for follow-on formulas. Conclusions Infant formulas are within the reference values of the European Technical Sanitary Regulations in terms of energy and macronutrients, but we believe that the level of micronutrients should be reviewed, based on current scientific data on infant requirements and possible adverse effects.

Iron intakes of Australian infants and toddlers: findings from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program.

Fe deficiency remains the most common nutritional deficiency worldwide and young children are at particular risk. Preventative food-based strategies require knowledge of current intakes, sources of Fe, and factors associated with low Fe intakes; yet few data are available for Australian children under 2 years. This study's objectives were to determine intakes and food sources of Fe for Australian infants and toddlers and identify non-dietary factors associated with Fe intake. Dietary, anthropometric and socio-demographic data from the Melbourne Infant Feeding, Activity and Nutrition Trial Program were analysed for 485 infants (mean age: 9·1 (sd 1·2) months) and 423 toddlers (mean age: 19·6 (sd 2·6) months) and their mothers. Dietary intakes were assessed via 24-h recalls over 3 non-consecutive days. Prevalence of inadequate Fe intake was estimated using the full probability approach. Associations between potential non-dietary predictors (sex, breast-feeding status, age when introduced to solid foods, maternal age, maternal education, maternal employment status and mother's country of birth) and Fe intakes were assessed using linear regression. Mean Fe intakes were 9·1 (sd 4·3) mg/d for infants and 6·6 (sd 2·4) mg/d for toddlers. Our results showed that 32·6 % of infants and 18·6 % of toddlers had inadequate Fe intake. Main food sources of Fe were Fe-fortified infant formula and cereals for infants and toddlers, respectively. Female sex and current breast-feeding were negatively associated with infant Fe intakes. Introduction to solid foods at or later than 6 months was negatively associated with Fe intake in toddlers. These data may facilitate food-based interventions to improve Australian children's Fe intake levels.

Nutrient intakes of infants and toddlers from maternal and child care centres in urban areas of China, based on one 24-hour dietary recall

An understanding of the diet of young children from infancy to early childhood in China is limited. The objective of this study is to evaluate nutrient intakes of young children from urban areas in China. Mothers, infants and children were recruited from maternal and child care centres as part of a cross-sectional survey of Maternal Infant Nutrition Growth (MING). One 24-h dietary recall was completed for a sample of infants and toddlers aged 6 to 35 months (n = 1409) via face-to-face interviews with the primary caregiver. Nutrient intakes were estimated using data from Chinese Food Composition tables and compared with the Adequate Intakes (AI) or Estimated Average Requirement (EAR) from China. Mean intakes of most nutrients met or exceeded AIs. Mean fat intakes (% energy) in all subgroups fell below the AIs (32 % vs. 40 % among infants; 31 % and 32 % vs. 35 % among younger and older toddlers). Mean intakes of vitamin B6, folate and selenium were below the AIs among infants (0.3 vs. 0.4 mg/d, 93 vs. 100 μg/d and 15.2 vs. 20 μg/d, respectively). A risk of inadequate iron intake was also observed in infants. Mean vitamin A intake exceeded the recommendations in all subgroups. Mean sodium intakes among toddlers significantly exceeded the AI. Based on one day dietary intake, the diets of the infants and toddlers appear to be adequate in mean intakes of most nutrients, with a few exceptions including risk of inadequate intakes of fat, vitamin B6, folate, iron and selenium among infants and risk of inadequate intake of fat, vitamin B6 and folate as well as excessive intakes of vitamin A and sodium among toddlers.

Copper, zinc and iron levels in infants and their mothers during the first year of life: a prospective study.

BackgroundEssential micronutrients are important for maintenance of life. Deficiency of micronutrients is more likely to be encountered in children, and women studies are required to investigate the status of micronutrients in children and women. This study aimed to longitudinally evaluate changes in zinc, copper, and iron levels in breastfed infants and their mothers during the first year of life.MethodsSerum and hair samples were obtained from 35 healthy breastfed infants (51 % males, 49 % females) and their mothers 2, 6, and 12 months after delivery. All of the samples were assessed using an atomic absorption spectrophotometer. Serum iron levels were determined by a Roche/Hitachi/Modular analyzer. Statistical analyses were performed using SPSS-PC (Version 21.00) software.ResultsHair zinc (p < 0.05) and serum iron (p < 0.001) levels of infants were significantly decreased towards the end of the first year. Infants’ serum copper levels were increased towards the end of the first year. Maternal serum and hair copper levels and serum iron levels were significantly decreased towards the end of the first year. There were no significant correlations between dietary zinc, copper, iron intake, and trace element levels of infants and their mothers.ConclusionsInfants’ hair zinc levels, maternal and infants’ hair copper levels, and infants’ and maternal serum iron levels declined towards the end of the first year. Infants need more zinc after 6 months of age. Infants’ and mothers’ daily iron intake was less than the recommended intake.

Electrolyte and Mineral Homeostasis After Optimizing Early Macronutrient Intakes in VLBW Infants on Parenteral Nutrition.

The aim of the present study was to evaluate electrolyte and mineral homeostasis in very-low-birth-weight (VLBW) infants who received high protein and energy intakes with a unique standardized parenteral nutrition solution containing electrolytes and minerals from birth onward. Prospective cohort study in 102 infants with birth weight <1250 g. The evolution of plasma biochemical parameters was described during the first 2 weeks of life. During the first 3 days of life, mean parenteral intakes were 51 ± 8 kcal · kg · day with 2.7 ± 0.4 g · kg · day of protein, 1.1 ± 0.2 mmol · kg · day of sodium and potassium, and 1.3 ± 0.2 mmol · kg · day of calcium and phosphorus. Afterwards, most nutritional intakes (parenteral and enteral) met growth requirements. No infant developed a hyperkalemia >7 mmol/L, and a hypernatremia >150 mmol/L occurred only in 15.7% of the infants. In contrast, hyponatremia <130 mmol/L and hypokalemia <3 mmol/L occurred in 30.4% and 8.8% of the infants, respectively. The initial neonatal metabolic acidosis rapidly resolved in most infants and only 2.0% developed a base deficit >10 mmol/L after day 3 of life. Early hypocalcemia <1.8 mmol/L occurred in 13.7% of the infants. In contrast, hypophosphatemia <1.6 mmol/L occurred in 37.3% and hypercalcemia >2.8 mmol/L occurred in 12.7% of the infants. Increasing early protein and energy intakes in VLBW infants in the first week of life improves electrolyte homeostasis. It also increases the phosphorus requirements with a calcium-to-phosphorus ratio ≤1.0 (mmol/mmol) and the potassium and sodium requirements to avoid the development of a refeeding-like syndrome. These data suggest that the parenteral nutrition guidelines for VLBW infants for the first week of life need to be revised.

Outcome of a public consultation on the Draft Scientific Opinion of the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) on Dietary Reference Values for iron

EFSA Supporting PublicationsVolume 12, Issue 10 876E Technical reportOpen Access Outcome of a public consultation on the Draft Scientific Opinion of the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) on Dietary Reference Values for iron European Food Safety Authority (EFSA), European Food Safety Authority (EFSA)Search for more papers by this author European Food Safety Authority (EFSA), European Food Safety Authority (EFSA)Search for more papers by this author First published: 21 October 2015 https://doi.org/10.2903/sp.efsa.2015.EN-876 Published date: 21 October 2015 Question number: EFSA-Q-2015-00260 AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. 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Breast milk composition and infant nutrient intakes during the first 12 months of life.

The objective of this study was to quantify human milk supply and intake of breastfed infants up to age 12 months. In addition, human milk composition was quantified per energetic macronutrient and fatty-acid composition in a subsample of lactating mothers. One hundred and seventy-four Italian breastfed children were followed using test-weighing and 3-day food protocols from birth to age 12 months. From a subsample of 30 mothers breast milk samples were collected at child ages one (T1), two (T2), three (T3) and six (T6) months, and were analyzed for the amount of protein, digestible carbohydrates, total lipids and fatty-acid composition. One hundred and forty-two (82%) filled in at least one 3-day food protocol within the first 12 months of life and complied with test-weighing of all milk feeds. The number of valid food protocols declined from 126 infants at 1 month to 77 at 12 months of age. Only galactose, non-protein nitrogen and protein decreased significantly from age 1 to age 6 months of lactation. Maternal body mass index and age affected fatty-acid levels in human milk. Median human milk intake decreased from 625 ml at T1, over 724 ml at T3 to 477 ml/day at T6. Average energy and %energy from protein intake per day increased from 419 kcal (s.d. 99) and 8.4% (1.0) at T1, respectively, to 860 kcal (145) and 16.1% (2.6) at T12. These data provide a reference range of nutrient intakes in breastfed infants and may provide guidance for defining optimal nutrient intakes for infants that cannot be fully breastfed.

Total and Differential Phylloquinone (Vitamin K1) Intakes of Preterm Infants from All Sources during the Neonatal Period.

All newborns require phylloquinone after birth to prevent vitamin K deficiency bleeding. Babies born prematurely may be at particular risk of deficiency without adequate supplementation during infancy. The main sources of phylloquinone in preterm babies during the neonatal period are the prophylactic dose of phylloquinone given at birth, and that derived from parenteral and/or enteral feeding. This observational study formed part of a prospective, multicentre, randomised, controlled trial that examined the vitamin K status of preterm infants after random allocation to one of three phylloquinone prophylactic regimens at birth (0.5 or 0.2 mg intramuscularly or 0.2 mg intravenously). In this nutritional sub-study we quantified the proportional and total phylloquinone intakes of preterm infants within the neonatal period from all sources. Almost all infants had average daily phylloquinone intakes that were in excess of the currently recommended amounts. In infants who did not receive parenteral nutrition, the bolus dose of phylloquinone given at birth was the major source of phylloquinone intake, whereas in infants who received parenteral nutrition, the intake from the parenteral preparation exceeded that from the bolus dose by a ratio of approximately 3:1. Our study supports the concern of others that preterm infants who receive current parenteral nutrition formulations may be receiving excessive vitamin K.

Threonine Requirement of the Enterally Fed Term Infant in the First Month of Life.

Threonine is one of the essential amino acids. Its major fate is incorporation into intestinal mucosal proteins and synthesis of secretory glycoproteins. Therefore, it has an important function in the neonatal gut barrier integrity. The objective was to quantify the threonine requirement in fully enterally fed term neonates by means of the indicator amino acid oxidation (IAAO) method, using L-[1-C]phenylalanine as indicator. After a 24-hour test diet adaptation, containing randomly assigned amounts of threonine (range 5-182 mg · kg · day), the participating neonates received a primed continuous infusion of [C]bicarbonate and L-[1-C]phenylalanine. At baseline and during the plateau phase of both infusions, breath samples were obtained for CO2. The fractional L-[1-C]phenylalanine oxidation (FCO2) was estimated and plotted against the threonine intakes. Biphasic linear regression crossover analysis was used to calculate the breakpoint of the FCO2, representing the mean threonine requirement. Data are presented as mean ± SD. Thirty-two term neonates (gestational age 39 ± 1 weeks, birth weight 3.3 ± 0.3 kg, mean postnatal age 10 ± 4 days) were studied. The mean threonine requirement was estimated to be 68 mg · kg · day with an upper and lower 95% confidence interval of 104 and 32 mg · kg · day, respectively (r = 0.37). The determined threonine requirement is extremely close to the existing requirement recommendations (∼90% of the present World Health Organization requirement guidelines). Infant formula preparations presently on the market, however, contain up to twice as much threonine as recommended. The threonine intake in formula-fed infants may therefore be reduced considerably.