Protein Requirements Of Children Research Articles

Dietary Protein Requirements in Children: Methods for Consideration.

The current protein requirement estimates in children were largely determined from studies using the nitrogen balance technique, which has been criticized for potentially underestimating protein needs. Indeed, recent advances in stable isotope techniques suggests protein requirement as much as 60% higher than current recommendations. Furthermore, there is not a separate recommendation for children who engage in higher levels of physical activity. The current evidence suggests that physical activity increases protein requirements to support accretion of lean body masses from adaptations to exercise. The indicator amino acid oxidation and the 15N-end product methods represent alternatives to the nitrogen balance technique for estimating protein requirements. Several newer methods, such as the virtual biopsy approach and 2H3-creatine dilution method could also be deployed to inform about pediatric protein requirements, although their validity and reproducibility is still under investigation. Based on the current evidence, the Dietary Reference Intakes for protein indicate that children 4–13 years and 14–18 years require 0.95 and 0.85 g·kg−1·day−1, respectively, based on the classic nitrogen balance technique. There are not enough published data to overturn these estimates; however, this is a much-needed area of research.

Energy and Protein Requirements in Children Undergoing Cardiopulmonary Bypass Surgery: Current Problems and Future Direction.

Congenital heart disease (CHD) is 1 of the most common congenital malformations, and considerable numbers of infants and young children with CHD undergo cardiopulmonary bypass surgery. It has been increasingly realized that perioperative nutrition support plays an important role in improving clinical outcomes. The purpose of this review, by searching PubMed, was to examine the nutrition conditions in perioperative children with CHD and the main problems in nutrition management in the cardiac intensive care unit (CICU), based on which future directions were proposed. We found that preoperative poor nutrition status is common. This limited reserve of energy and protein is further compounded by the complex metabolic alterations with hypermetabolism, hypercatabolism, and hypoanabolism in the early postoperative course. Knowledge about energy and protein metabolism and requirements in children after cardiopulmonary bypass remains very limited. The current nutrition recommendations in the CICU are based on little evidence. Insufficient energy and protein supply to meet demands remains a norm in the immediate postoperative period. The commonly used predictive equations do not provide accurate estimate of energy requirement in individual patients during the highly dynamic postoperative course. Indirect calorimetry can provide the best estimate of energy requirements for children with CHD in the CICU. Measurement of nitrogen balance is the recommended method to determine the minimal protein requirement. During the early postoperative period, daily measurements of resting energy expenditure using indirect calorimetry and nitrogen balance in each individual child are essential to optimize energy and protein supply to meet requirements.

Protein Requirements of the Critically Ill Pediatric Patient.

This article includes a review of protein needs in children during health and illness, as well as a detailed discussion of protein metabolism, including nitrogen balance during critical illness, and assessment and prescription/delivery of protein to critically ill children. The determination of protein requirements in children has been difficult and challenging. The protein needs in healthy children should be based on the amount needed to ensure adequate growth during infancy and childhood. Compared with adults, children require a continuous supply of nutrients to maintain growth. The protein requirement is expressed in average requirements and dietary reference intake, which represents values that cover the needs of 97.5% of the population. Critically ill children have an increased protein turnover due to an increase in whole-body protein synthesis and breakdown with protein degradation leading to loss of lean body mass (LBM) and development of growth failure, malnutrition, and worse clinical outcomes. The results of protein balance studies in critically ill children indicate higher protein needs, with infants and younger children requiring higher intakes per body weight compared with older children. Monitoring the side effects of increased protein intake should be performed. Recent studies found a survival benefit in critically ill children who received a higher percentage of prescribed energy and protein goal by the enteral route. Future randomized studies should evaluate the effect of protein dosing in different age groups on patient outcomes, including LBM, muscle structure and function, duration of mechanical ventilation, intensive care unit and hospital length of stay, and mortality.

The Indicator Amino Acid Oxidation Method with the Use of L-[1-13C]Leucine Suggests a Higher than Currently Recommended Protein Requirement in Children with Phenylketonuria

BackgroundPhenylketonuria is characterized by mutations in the Phe hydroxylase gene that leads to the accumulation of Phe in plasma and the brain. The standard of care for phenylketonuria is nutritional management with dietary restriction of Phe and the provision of sufficient protein and energy for growth and health maintenance. The protein requirement in children with phenylketonuria is empirically determined based upon phenylketonuria nutritional guidelines that are adjusted individually in response to biochemical markers and growth. ObjectiveWe determined dietary protein requirements in children with phenylketonuria with the use of the indicator amino acid oxidation (IAAO) technique, with L-[1-13C]Leu as the indicator amino acid. MethodsFour children (2 males; 2 females) aged 9–18 y with phenylketonuria [mild hyperphenylalanemia (mHPA); 6–10 mg/dL (360–600 μmol/L)] were recruited to participate in ≥7 separate test protein intakes (range: 0.2–3.2 g ⋅ kg−1 ⋅ d−1) with the IAAO protocol with the use of L-[1-13C]Leu followed by the collection of breath and urine samples over 8 h. The diets were isocaloric and provided energy at 1.7 times the resting energy expenditure. Protein was provided as a crystalline amino acid mixture based on an egg protein pattern, except Phe and Leu, which were maintained at a constant across intakes. Protein requirement was determined with the use of a 2-phase linear-regression crossover analysis of the rate of L-[1-13C]Leu tracer oxidation. ResultsThe mean protein requirement was determined to be 1.85 g ⋅ kg−1 ⋅ d−1 (R2 = 0.66; 95% CI: 1.37, 2.33). This result is substantially higher than the 2014 phenylketonuria recommendations (1.14–1.33 g ⋅ kg−1 ⋅ d−1; based on 120–140% above the current RDA for age). ConclusionsTo our knowledge, this is the first study to directly define a quantitative requirement for protein intake in children with mHPA and indicates that current protein recommendations in children with phenylketonuria may be insufficient. This trial was registered at clinicaltrials.gov as NCT01965691.

Acceptability, Nutritional Quality and Contribution of Vegetable-Enriched Products to Nutrient and Energy Requirements of School Children Aged 5 to 13 Years

Micronutrient deficiency (MD) is a problem among schoolchildren which, in addition to other effects, also affects their intellectual abilities. Inclusion of vegetables to food formulations can help to reduce MD because they contain vital micronutrients which are required for improved school performance. This study aimed at evaluating acceptability, determining the nutritional quality and estimating the contribution of vegetable enriched products to the Recommended Dietary Allowance (RDA) of schoolchildren (5 to 13 years). The vegetables used were red and green amaranth leaves, orange fleshed sweet potato and pumpkin. Selection of vegetables was based on richness in micronutrients; local availability and consumption levels in Uganda; and their underutilization status particularly in processed form. Each of the vegetables was preprocessed and incorporated separately into soybean and grain amaranth in the ratio of 10:40:50, respectively, to improve the nutrient and energy density of the formulations. Sensory screening of formulations in a range of products (porridges, soups and snacks) revealed that orange fleshed sweet potato formulation was most preferred for porridge as well as for snacks (at 30:70 ratio of orange fleshed sweet potato composite to wheat flour); while red amaranth leaves composite was most preferred for soup. When tested for acceptability, nutritional quality, as well as contribution to the RDA (for vitamin A, iron, zinc, protein and energy) for schoolchildren 5 to 13 years, acceptability tests and nutritional quality of food products from the formulations were highly rated compared to commercial products (pure maize porridge, wheat based soup and 100% refined wheat flour snacks). All products from the two formulations contributed favourably to vitamin A, iron, zinc and protein requirements of children (5 to 13 years). Based on these findings, orange fleshed sweet potato composite flour can be recommended for making porridge, and can substitute (30%) for wheat flour in making snacks; while red amaranth leaf composite flour can be recommended for making soups.

Protein Requirements in Children with Phenylketonuria (PKU)

Phenylketonuria (PKU) is an inherited inborn error of phenylalanine (PHE) metabolism caused by deficiency of the hepatic enzyme, phenylalanine hydroxyls (PAH). Therefore PHE accumulates in plasma l...

Protein requirement of healthy school-age children determined by the indicator amino acid oxidation method

The current Dietary Reference Intake (DRI) recommendations for protein requirements in children are based on a factorial estimate and have not been directly determined. The objective of the current study was to determine the protein requirement in healthy, school-age children by measuring the oxidation of L-[1-(13)C]-phenylalanine to (13)CO(2) [label tracer oxidation (F(13)CO(2))] in response to graded intakes of protein. Seven healthy children (6-11 y old) each randomly received a minimum of 7 protein intakes (range: 0.1-2.56 g · kg(-1) · d(-1)) for a total of 56 studies. The diets provided energy at 1.7 times the resting energy expenditure and were made isocaloric by using carbohydrate. Protein was given as an amino acid mixture on the basis of the egg-protein pattern, except for phenylalanine and tyrosine intakes, which were maintained constant across intakes. The mean protein requirement was determined by applying a 2-phase linear regression crossover analysis on F(13)CO(2) data, which identified a breakpoint (requirement) at minimal F(13)CO(2) in response to graded amounts of protein intake. Mean and population-safe (upper 95% CI) protein requirements were determined to be 1.3 and 1.55 g · kg(-1) · d(-1), respectively. These results are significantly higher than the mean and population-safe protein requirements currently recommended by the DRI 2005 for macronutrients (0.76 and 0.95 g · kg(-1) · d(-1), respectively). To our knowledge, this study was the first to directly estimate protein requirements in children by using stable isotopes and indicated that current recommendations are severely underestimated.

PROTEIN requirements of children.

PROTEIN requirements of children.

Protein requirements in healthy school‐age children determined by using the indicator amino acid oxidation technique

Protein (PRO) requirements in school‐age children were determined by the indicator amino acid oxidation (IAAO) method. Four, healthy children (8 – 11 yr) each randomly received a minimum of three PRO intakes below 0.9 and three intakes above 0.9 g/kg/d; range = 0.16 – 1.84 g/kg/d. The diets were isocaloric and provided energy at 1.7 X REE. PRO was given as an amino acid mixture based on egg protein composition, except phenylalanine which was maintained constant across intakes. PRO requirements were determined by measuring the oxidation of L‐[1‐13C]‐phenylalanine to 13CO2 (F13CO2). Breath and urine samples were collected at baseline and isotopic steady state. Linear regression crossover analysis identified a breakpoint (requirement) at minimal F13CO2 in response to different PRO intakes.Preliminary results indicate the mean and population‐safe PRO requirements to be 1.35 and 1.59 g/kg/d, respectively. These results are significantly higher than the mean and population‐safe PRO requirements of 0.76 and 0.95 g/kg/d, respectively, currently recommended by the Dietary Reference Intakes (DRI 2005) for macronutrients This study is the first to directly estimate protein requirements in children and suggests that the current recommendations, based on a factorial method are severely underestimated. (CIHR supported)

Determination of Macronutrients, by Chemical Analysis, of Home-Prepared Milk Feeding Bottles and their Contribution to the Energy and Protein Requirements of Infants from High and Low Socioeconomic Classes

Objectives: To determine the macronutrients composition of home-prepared milk feeding bottles, by chemical analysis, and assess their contribution to the energy and protein requirements of children under two years of age from high (HSE) and low (LSE) socioeconomic classes.Methods: 72 samples were analyzed for energy density and protein, fat and carbohydrate content: 41 from the LSE group and 31 from the HSE group. The assessment of the percentages of the energy and protein requirements met by the consumption of the milk bottles was calculated as follows: the energy and protein per 100 mL obtained through chemical analysis were multiplied by the volume consumed at each feeding, then by the number of feedings per day, the results divided by the energy and protein requirements and multiplied by 100. Energy and protein requirements were those recommended by the FAO/WHO/UNU Committee and the Food and Nutrition Board. The children’s weight-for-age index was assessed.Results: Unmodified cow’s milk was largely consumed by both groups. The addition of sugar and other ingredients to the milk was significantly higher in the LSE group. Moisture, protein and fat content were lower in the LSE group, whereas carbohydrate and energy content were higher. The percentages of energy and protein requirements provided by feeding bottles were higher in the LSE group. Children in the LSE group had lower z-scores for weight-for-age.Conclusions: Differences in the preparation practices led to differences in the chemical results. The feeding bottles in the LSE group were high in energy, due to the addition of sugar and cereals to the milk in the bottle. The milk feeding bottles were an important weaning food providing more than 50% and 100% of the children’s energy and protein requirements, respectively. The children’s weight-for-age index was within the normal limits.

Effect of Diet Composition on Protein Requirements of Children and Adults in Northern Mexico

The overall vegetable and animal protein combinations of the diet in Northern Mexico were determined through a dietary population survey. Vegetable sources made up 45% and animal protein was 55% (45V/55A). Further combinations of up to 100% vegetable protein dietary mixtures (100V) were studied to test the sensibility of the variations on protein requirements of pre-school, school children and adults. Diets were analyzed for amino acid composition and in vivo protein digestibility in rats to estimate true protein requirements according to FAO/WHO/UNU (1985). The effect on the pre-school group showed the widest variation with 1.46 g/kg/day in the 45V/55A to 2.63 in the 100V. For the school-aged children and adults the variations were 1.15-1.79 and 0.94-0.84 g/kg/day respectively.

Nutritional value and economic aspects of fortification of foods of plant origin with soy protein.

The protein requirements of children and adults are reviewed in comparison with the protein qualities of several foods with and without added soy. The economic considerations greatly favor soy containing foods for equivalent nutrition.

The protein requirements of children from one to ten years of age.

The protein requirements of children from one to ten years of age.

RELATIONSHIP OF BASAL METABOLISM TO DIETARY INTAKE

In a study of the caloric and protein requirements of children we have noted the well established phenomenon of a lowering of the basal metabolic rate with submaintenance diets. It was our plan to arrive at requirement figures by starting at admittedly low levels and increasing the intake to a point at which there was not only growth, as shown by increased weight and height, but a positive nitrogen balance as well. Because of the indications of a relationship between intake and the basal metabolic rate, the diets were then increased to the maximum intake, and an attempt was made to determine whether variations in the intake of protein affected the level of metabolism or whether the total caloric intake alone was the deciding factor. <h3>PLAN AND METHODS OF STUDY</h3> The study extended over three years. The subjects were thirty-three children, who were maintained on measured diets for periods averaging

The Importance of The Protein Requirement of Children In Modern Specific Diet Therapy1

The Importance of The Protein Requirement of Children In Modern Specific Diet Therapy1