Protein and Energy Requirements in Infancy and Childhood

Protein and Energy

Requirements in Infancy

and Childhood

EditorsJacques Rigo, Liège, BelgiumEkhard E. Ziegler, Iowa City, IA, USA

Nestlé Nutrition Workshop Series

Pediatric Program, Vol. 58

Nestec Ltd., 55 Avenue Nestlé, CH–1800 Vevey (Switzerland)

S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland) www.karger.com

© 2006 Nestec Ltd., Vevey (Switzerland) and S. Karger AG, Basel (Switzerland). All rights reserved.This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, ortransmitted, in any form or by any means, electronic, mechanical, photocopying, or recording, orotherwise, without the written permission of the publisher.

Printed in Switzerland on acid-free paper by Reinhardt Druck, BaselISSN 1661–6677ISBN-10: 3–8055–8081–9ISBN-13: 978–3–8055–8081–6

Library of Congress Cataloging-in-Publication Data

Protein and energy requirements in infancy and childhood / editors, Jacques Rigo, Ekhard E. Ziegler.p. ; cm. – (Nestlé Nutrition workshop series. Pediatric program,

ISSN 1661–6677 ; v. 58)Includes bibliographical references and index.ISBN 3-8055-8081-9 (hard cover : alk. paper)1. Infants–Nutrition. 2. Children–Nutrition. 3. Proteins. 4. Deficiency

diseases. I. Rigo, Jacques. II. Ziegler, Ekhard E. III. Nestlé NutritionInstitute. IV. Series: Nestlé Nutrition workshop series. Paediatric programme ; v. 58.

[DNLM: 1. Child Nutrition. 2. Infant Nutrition. 3. NutritionalRequirements. W1 NE228D v.58 2006 / WS 130 P967 2006]RJ206.P76 2006618.92�01–dc22

2006012322

Basel · Freiburg · Paris · London · New York ·

Bangalore · Bangkok · Singapore · Tokyo · Sydney

The material contained in this volume was submitted as previously unpublished material, except inthe instances in which credit has been given to the source from which some of the illustrative materialwas derived.

Great care has been taken to maintain the accuracy of the information contained in the volume.However, neither Nestec Ltd. nor S. Karger AG can be held responsible for errors or for anyconsequences arising from the use of the information contained herein.

V

Contents

VII Foreword

XI Contributors

Requirements for Protein and Energy

1 Long-Term Consequences of Early Feeding on

Later Obesity Risk

Koletzko, B. (Germany)

19 Energy Requirements of Infants and Children

Butte, N.F. (USA)

39 Protein Requirements of Infants and Children

Garlick, P.J. (USA)

Body Composition and Growth

51 Growth of Breast-Fed and Formula-Fed Infants

Ziegler, E.E. (USA)

65 Body Composition during the First Year of Life

Rigo, J. (Belgium)

79 Dietary Reference Intakes: Concepts and Approaches

Underlying Protein and Energy Requirements

Yates, A.A. (USA)

High Intakes of Protein and Amino Acids

95 Intestinal Amino Acid Metabolism in Neonates

van Goudoever, J.B.; van der Schoor, S.R.D (The Netherlands); Stoll, B.; Burrin, D.G. (USA); Wattimena, D.; Schierbeek, H.; Schaart,M.W.; Riedijk, M.A.; van der Lugt, J. (The Netherlands)

109 Amino Acid Requirements of Infants and Children

Pencharz, P.B.; Ball, R.O. (Canada)

121 Effects of High Protein Intakes

Axelsson, I. (Sweden)

Complementary Foods

133 Physiology of Food Intake Regulation: Interaction

with Dietary Components

Anderson, G.H.; Aziz, A.; Abou Samra, A. (Canada)

147 Complementary Food: International Comparison

on Protein and Energy Requirement/Intakes

Agostoni, C.; Riva, E.; Giovannini, M. (Italy)

161 What Is the Optimal Age for Introduction of

Complementary Foods?

Dewey, K.G. (USA)

New Proteins in Infant Feeding

177 Recent Issues in Energy-Protein Malnutrition in Children

Desjeux, J.-F. (France)

189 Protein Quality and Quantity in Cow’s Milk-Based Formula

for Healthy Term Infants: Past, Present and Future

Macé, K.; Steenhout, P. ; Klassen, P.; Donnet, A. (Switzerland)

207 Recombinant Human Milk Proteins

Lönnerdal, B. (USA)

219 Concluding Remarks

225 Subject Index

Contents

VI

VII

Foreword

The topic ‘Protein and Energy Requirements in Infancy and Childhood’ waschosen for the 58th Nestlé Nutrition Pediatric Workshop, which took place inNovember 2005 in Ho Chi Minh City, Viet Nam. In 1993 the 33rd NestléNutrition Workshop on ‘Protein Metabolism during Infancy’, chaired by Prof.Niels Raïhä, was held in South Africa. In this workshop, Prof. Raïhä

introduced a new concept in terms of protein requirements, proposing areduction in the protein level of infant formulas in order to come closer to thatof human milk. In 2000, the workshop entitled ‘Infant Formula: Closer to theReference’ (Nestlé Nutrition Workshop Series, Vol. 47, supplement) chairedby Prof. Niels Raïhä and Prof. Firmino Rubaltelli, included a review of morerecent information showing the safety and efficacy of reducing the proteincontent of infant formulas to a level closer to that of human milk.

The outcome of these workshops has enabled Nestlé R&D to successfullydevelop a new generation of starter infant formulas with significantly impro-ved protein quality at the level of 1.8 g/100 kcal, coming closer to that ofhuman milk during early lactation. After successful clinical testing, thesestarter infant formulas are now soliciting high interest among infant healthprofessionals. Of late, attention has also focused on whether or not it may alsobe desirable to optimize the protein quality and reduce the protein level offollow-up infant formulas. Moreover, other studies have suggested associationsbetween protein nutrition in the first year of life, and the subsequent risk ofobesity, diabetes and other related chronic diseases. Whilst proteinrequirements have received a great deal of attention, the aspect of energyrequirements has never been reviewed on a systematic basis in the NestléNutrition Workshop Series. Hence we believe it is timely to review the latestknowledge on the energy and protein requirements of infants and children.

We wish to thank the two chairpersons, Prof. Ekhard E. Ziegler and Prof.Jacques Rigo, recognized experts in this field, for establishing the workshopprogram and for bringing together the key opinion leaders in the field ofprotein and energy requirements.

Ekhard E. Ziegler, Professor of Pediatrics and Head of the Samuel J.Fomon Infant Nutrition Unit, at the University of Iowa, USA, is well known forhis work on protein metabolism. Prof. Jacques Rigo is the Head of theNeonatal Department of the University of Liege in Belgium and a member ofthe ESPGHAN Committee of Nutrition.

We also thank Mrs. Montip Nagsevi and Mrs. Vipapan Panitantum andtheir team from Nestlé Viet Nam who provided all logistical support, enablingparticipants from around the globe to enjoy the superb Vietnamesehospitality.

Prof. Ferdinand Haschke, MD, PhD Dr. Denis Barclay, PhD

Vice President and Chairman Scientific AdvisorNestlé Nutrition Institute Nestlé Nutrition InstituteVevey, Switzerland Vevey, Switzerland

Foreword

VIII

58th Nestlé Nutrition WorkshopPediatric ProgramHo Chi Minh City, Viet Nam, November 20–24, 2005

XI

Contributors

Chairpersons & Speakers

Prof. Carlo Agostoni

University of MilanDepartment of PediatricsSan Paolo Hospital8, via A. di RudiniIT–20142 MilanItalyE-Mail carlo.agostoni@unimi.it

Prof. Harvey Anderson

Department of Nutritional SciencesRm 322, FitzGerald BuildingUniversity of Toronto150 College StreetToronto, Ont. M5S 3E2CanadaE-Mail harvey.anderson@utoronto.ca

Prof. Irene Axelsson

Children’s HospitalDepartment of PaediatricsUniversity Hospital of LundSE–222185 LundSwedenE-Mail irene.axelsson@med.lu.se

Prof. Nancy Butte

Children’s Nutrition Research CenterDepartment of PediatricsBaylor College of Medicine1100 Bates StreetHouston, TX 77030USAE-Mail nbutte@bcm.tmc.edu

Prof. Jehan-FrançoisDesjeux

Conservatoire National des Arts etMétiers2, rue Conté FR–75003 ParisFranceE-Mail desjeux@cnam.fr

Prof. Kathryn Dewey

Department of NutritionUniversity of CaliforniaOne Shields AvenueDavis, CA 95616USAE-Mail kgdewey@ucdavis.edu

Prof. Peter Garlick

University of IllinoisDepartment of Animal SciencesASL 4321207 West Gregory DriveUrbana, IL 61801USAE-Mail pgarlick@ad.uiuc.edu

Prof. Berthold Koletzko

Division of Metabolic Diseases andNutritional MedicineDr. von Hauner Children’s HospitalLudwig Maximilian University of MunichLindwurmstrasse 4DE–80337 MunichGermanyE-Mail berthold.koletzko@med.uni-muenchen.de

XII

Prof. Bo Lönnerdal

Department of NutritionUniversity of CaliforniaOne Shields AvenueDavis, CA 95616USAE-Mail bllonnerdal@ucdavis.edu

Dr. Katherine Macé

Nestlé Research CenterNutrition and HealthPO Box 44CH–1000 Lausanne 26SwitzerlandE-Mailcatherine.mace@rdls.nestle.com

Prof. Paul B. Pencharz

Departments of Paediatrics andNutritional SciencesHospital for Sick ChildrenUniversity of Toronto555 University AvenueToronto, Ont. M5G 1X8CanadaE-Mail paul.pencharz@sickkids.ca

Prof. Jacques Rigo

CHR Citadelle NéonatologieUniversity of LiègeBlvd du XII de Ligne 1BE–4000 LiègeBelgiumE-Mail j.rigo@ulg.ac.be

Prof. Johannes B. vanGoudoever

Erasmus MC/Sophia Children’sHospitalNeonatologyDr. Molewaterplein 60NL–3015 GJ RotterdamThe NetherlandsE-Mail j.vangoudoever@erasmusmc.nl

Prof. Allison A. Yates

Environ Health Sciences Institute4350 N. Fairfax Drive, Suite 300Arlington, VA 22203USACurrent E-Mail yatesa@ba.ars.usda.gov

Prof. Ekhard E. Ziegler

Department of PediatricsUniversity of Iowa200 Hawkins DriveIowa City, IA 52242-1083USAE-Mail ekhard-ziegler@uiowa.edu

Contributors

Dr. Thi Lan Huong Do

Department of Community HealthInstitute of Hygiene and PublicHealth159 Hung Phu, District 8Ho Chi Min CityViet NamE-Mail lanhuongdr@yahoo.com

Prof. Van Dung Do

University of Medicine and PharmacyCenter for Medical Education159 Hung Phu, District 8Ho Chi Minh CityViet NamE-Mail dovandung@fphhcm.org

Moderators

XIII

Prof. Cong Khanh Nguyen

Department of HematologyNational Hospital of PaediatricsNo. 18, Lane 879La Thanh AvenueDong Da District, HanoiViet NamE-Mail hoangnam9@yahoo.com

Prof. Gia Khanh Nguyen

No. 20, Hang Hom StreetHoan Kiem DistrictHanoiViet NamE-Mailnguyengiakhanh1945@yahoo.com

Prof. Thu Nhan Nguyen

4D/02 Home No. 2Dang Van Ngu StreetDong Da DistrictHanoiViet NamE-Mail ng.thunhan@fpt.vn

Contributors

Dr. Md. Jahangir Alam/BangladeshProf. Francisco Martinez/BrazilProf. Nelson Diniz Oliveira/BrazilProf. Hugo Ribeiro/BrazilProf. Evanguelia Shwetz/BrazilDr. Ivor Margolis/CanadaDr. Reg Sauve/CanadaDr. Yun Cao/Greater China RegionDr. Yutao Cui/Greater China RegionDr. Zhuoqin Jiang/Greater China

RegionDr. Hanchu Liu/Greater China RegionDr. Fan Yang/Greater China RegionDr. Yi-hung Chou/Greater China

Region (Taiwan)Dr. Shiuh-Bin Fang/Greater China

Region (Taiwan)Dr. Ali Purbaya Arwin Akib/IndonesiaDr. Dany Hilmanto/IndonesiaDr. Muhammad Heru

Muryawan/IndonesiaDr. Adrian Umboh/IndonesiaProf. Marcello Assumma/ItalyProf. Marcello Giovannini/ItalyDr. Paola Roggero/ItalyDr. Mohd Suhaimi Abdul

Wahab/MalaysiaDr. Noor Khatijah Nurani/MalaysiaDr. Samuel Flores Huerta/MexicoDr. Edgar Vazquez Garibay/MexicoDr. Homero Martinez/Mexico

Prof. Hendrik Nicolaas Lafeber/TheNetherlands

Dr. Felizardo Gatcheco/PhilippinesProf. João Gomes-Pedro/PortugalProf. Alberto Antonio

Moreira/PortugalDr. Enriqueta Roman/SpainDr. Abdulwahab Telmesani/Saudi

ArabiaProf. Yam Thiam Daniel

Goh/SingaporeDr. Kah Tzay Low/SingaporeProf. Mehari Gebre-Medhin/SwedenProf. Olle Hernell/SwedenProf. Peter Baehler/SwitzerlandProf. Christian Peter

Braegger/SwitzerlandDr. Mahmoud Bozo/SyriaProf. Pramote Praisuwanna/ThailandDr. Robert Baker/USADr. Susan Baker/USADr. An Binh Bui/Viet NamMr. Quoc Lap Chu/Viet NamProf. Trong Kim Hoang/Viet NamDr. Nam Tra Le/Viet NamProf. Cong Khan Nguyen/Viet NamProf. Duc Vy Nguyen/Viet NamDr. The Dung Nguyen/Viet NamDr. Thi Hoa Nguyen/Viet NamProf. Thi Lam Nguyen/Viet NamDr. Thi Thanh Binh Nguyen/Viet Nam

Invited attendees

XIV

Dr. Trong Hieu Nguyen/Viet NamMr. Xuan Mai Nguyen/Viet NamDr. Gia Tien Pham/Viet NamMr. Dang Tran/Viet Nam

Mr. Quang Trung Tran/Viet NamMr. Trong Hai Tran/Viet NamProf. Cong Dong Vo/Viet NamDr. Thi Nhung Vu/Viet Nam

Contributors

Dr. Louis Dominique VanEgroo/France

Ms. Kelan Liu/Greater China RegionDr. Leilani Lestarina/IndonesiaMs. Mei Ching Wong/MalaysiaMs. Po Poh Yap/MalaysiaMs. Marjan Skotnicki-Hoogland/The

NetherlandsMs. Audrey Liow/SingaporeDr. Anette Järvi/SwedenDr. Denis Barclay/Switzerland

Dr. Bianca-Maria Exl-Preysch/Switzerland

Prof. Ferdinand Haschke/SwitzerlandDr. Petra Klassen/SwitzerlandMs. Edith Koch/SwitzerlandDr. Evelyn Spivey-Krobath/

SwitzerlandDr. Philippe Steenhout/SwitzerlandMs. Vipapan Panitantum/ThailandMs. Aummaruta Sirichai/ThailandMs. Montip Nagsevi/Viet Nam

Nestlé participants