Protein and energy requirements for ‘optimal’ catch-up growth

Access through your institution Buy or subscribe Protein and energy requirements in childhood can be considered as being made up of components such as maintenance and growth (Panel on

Macronutrients, 2002/2005; Report of a Joint FAO/WHO/UNU Expert Consultation, 2004; Report of a Joint WHO/FAO/UNU Expert Consultation, 2007). This approach can readily be applied to the

question of catch-up growth (Report of a Joint WHO/FAO/UNU Expert Consultation, 2007). Enteral nutrition requirements depend on the efficiency of digestion and absorption of protein (amino

acids) and non-protein energy (carbohydrate and fats; Panel on Macronutrients, 2002/2005). The initial approach of catch-up growth depends on the degree and type of undernutrition, namely

adapted (normal plasma albumin or marasmus) or disadapted (reduced plasma albumin or Kwashiorkor). In adapted undernutrition the gut mucosal function is relatively normal, so the

child's intake can be progressively increased to high levels (>200 kcal/kg/day). In children with disadapted undernutrition, there are two aspects to consider. First, the gut mucosa

is atrophied and gut function limited. Second, with hypo-albuminaemia there is intra-vascular volume contraction and whole-body depletion of K and P, which contribute to the so-called

‘re-feeding syndrome’. Hence, to avoid the re-feeding syndrome, initially children need to be fed at levels that are only 10–20% above the resting metabolic rate. Experience has shown that,

once diuresis occurs, the gut mucosa and intestinal function recovers enough to progressively increase intakes up to the high levels used for adapted undernourished children. This is a

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during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support REFERENCES * Bross R, Ball RO, Clarke JTR, Pencharz

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Digital Educational Publishing Inc.: Cincinnati, OH. pp 37–56. Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Departments of Paediatrics and Nutritional

Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada P B Pencharz Authors * P B Pencharz View author publications You can also search for this author inPubMed 

Google Scholar CORRESPONDING AUTHOR Correspondence to P B Pencharz. ETHICS DECLARATIONS COMPETING INTERESTS PB Pencharz has received grant support from CIHR. RIGHTS AND PERMISSIONS Reprints

and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Pencharz, P. Protein and energy requirements for ‘optimal’ catch-up growth. _Eur J Clin Nutr_ 64 (Suppl 1), S5–S7 (2010).

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