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Objective: To evaluate the adequacy of protein intakes now recommended as safe for infants and toddlers., Methods: Subjects were recovering malnourished infants, age 5.3 to 17.9 months, length age (LA) 2.5 to 6.4 months, weight age (WA) 1.5 to 5.2 months, weight/length (W/L) 78% to 100% of National Center for Health Statistics data; and toddlers age 11.4 to 31.6 months, LA 6.1 to 17.9 months, WA 3.9 to 12.0 months, W/L 79% to 99%. Infants were assigned at random to formulas with 5.5%, 6.7%, or 8.0% energy as 60:40 whey:casein protein. The 5.5% was based on FAO-WHO-UNU safe protein and average energy for ages 2.5 to 6.0 months. Toddlers received 4.7% (recommended for 6 to 18 months), 6.4%, or 8.0%. Identical concentrations (weight/kcal) of other nutrients were maintained; intakes were adjusted weekly to reach, in 90 days, the 50th percentile of weight for a LA 3 months greater than the initial one., Results: Infants consumed 125 +/- 11 (SD), 116 +/- 10, and 126 +/- kcal and 1.7 +/- 0.1, 1.9 +/- 0.2, and 2.5 +/- 0.3 g protein kg-1 . d-1; gained 2.4 +/- 0.7, 2.9 +/- 0.7, and 2.6 +/- 0.5 months in LA, and reached a W/L of 105 +/- 5, 103 +/- 6, and 105 +/- 5% of reference. Sum of four fat-folds (sigma FF) grew 13.1 +/- 6.9, 10.4 +/- 4.8, and 11.7 +/- 5.3 mm to 32.5 +/- 5.2, 31.7 +/- 4.7, and 30.5 +/- 5.5 mm; arm muscle areas (AMA) 57%, 51%, 70% to 1004 +/- 109, 1017 +/- 110, and 1004 +/- 116 mm2, still low; arm fat areas (AFA) 93%, 66%, and 93% to higher-than-normal 598 +/- 105, 610 +/- 101, and 541 +/- 116 mm2. Regression of intake on weight gain estimated energy for maintenance + activity to be 81.0 +/- 7.5 (SEM) kcal . kg-1 . d-1, and cost of gain (storage + metabolic cost) as 7.6 +/- 1.7 kcal/g, with no significant effect of % protein. Toddlers consumed 107 +/- 9, 103 +/- 12, and 105 +/- 10 kcal and 1.3 +/- 0.1, 1.6 +/- 0.2, and 2.1 +/- 0.2 g protein . kg-1 . d-1, gained 3.3 +/- 0.7, 2.9 +/- 0.6, and 3.3 +/- 0.7 months in LA; to a W/L of 102 +/- 1, 102 +/- 3, and 101 +/- 4%. Sigma FF grew 9.2 +/- 4.0, 7.4 +/- 4.3, and 6.0 +/- 3.8 to 28.9 +/- 5.2, 30.5 +/- 3.7, and 27.0 +/- 2.7 mm; AMA 31%, 33%, and 34% to 1121 +/- 115, 1124 +/- 110, and 1117 +/- 120 mm2; AFA 53%, 44%, and 45% to higher-than normal 578 +/- 106, 636 +/- 99, and 569 +/- 68 mm2. Cost of maintenance + activity was 70.8 +/- 3.8 (SEM) kcal . kg-1 . d-1, that of weight gain 9.7 +/- 1.35 kcal/g, with no effect of % protein., Conclusions: Within age groups, there were no significant protein-related differences in growth. In both infants and toddlers, high-energy intakes resulted in mild obesity, with lean body mass still deficient. Protein intakes two SD below the means in the lowest protein/energy cells, 1.5 g . kg-1 . d-1 for infants and 1.1 g times kg-1 . d-1 for toddlers, should still be safe for nearly all children of comparable biological ages.

An infant formula based on high protein rice flour, with added lysine and threonine, was evaluated in recovering malnourished infants. Acceptability, tolerance, and the digestibility of most major nutrients (energy 93.9 +/- 0.7%, fat 96.9 +/- 0.3%, carbohydrate 96.8 +/- 0.6% of intake) were excellent. Digestibility of protein, as with all rice products, was moderately low (80.1 +/- 3.3%), but its high biological value made N retention equal to that from casein. Plasma-free amino acids were consistent with the low essential/total amino acids ratio found in cereals, with slower absorption, and with the possibility that leucine was the first-limiting amino acid. Absorptions of Ca, Mg, PO4, and Zn were considered satisfactory. Energy costs of weight gain and the estimated percentage N in the weight gained during 14 days were comparable to those attained with the highest quality cow's milk-derived formulas in children of similar ages and nutritional status.

Earlier studies demonstrated that quality protein maize (QPM), with increased lysine and tryptophan and decreased leucine contents, was more digestible and supported 45% greater nitrogen retention than common maize. Ten recovering malnourished children (ages 13 to 29 months, height-ages 5 to 15 months, weight-ages 3 to 11 months) have now received 90% of their diet energy and 100% of protein and fat from QPM. Energy intake was adjusted to allow them to reach the 50th centile of weight-for-length (according to the National Center for Health Statistics) in 90 days (two completed 60 days only). Growth was compared with that of 10 children receiving modified cow's milk formula (CMF). Energy intakes (QPM 110 +/- 15, CMF 106 +/- 12, corrected for absorption to 94 and 97 kcal/kg.d), crude energy costs of gain (43 +/- 9 and 40 +/- 10, corrected to 37 and 37 kcal/g), linear growth (1.23 +/- 0.24 and 1.33 +/- 0.26 cm/mo), gains in height-age (3.1 +/- 0.7 and 3.3 +/- 1.2 mo), weight gain (2.6 +/- 0.6 and 2.6 +/- 0.8 g/kg.d), and final sums of fat folds (24.3 +/- 3.5 and 27.2 +/- 2.9 mm) were not different. Gains in weight-age were greater (7.5 +/- 2.3 vs 5.4 +/- 1.6 months, P less than .05) and serum albumin decreased (4.10 +/- 0.24 to 3.77 +/- 0.31 g/dL, P less than .01) during QPM feeding. Plasma-free total essential amino acids and ratio of these to total essential amino acids were less after QPM than after CMF diets. Equal growth rates with QPM and CMF diets offer great potential for developing- and developed-country children.

Post-prandial (p.p.) changes in plasma free amino acid (AA) concentrations of children consuming a single source of protein at critical levels are determined by its digestibility and total essential AA/total AA ratios; the molar proportion of the limiting EAA (EAA/TEAA), if any, will fall significantly in plasma as it is utilized more completely than others. Grain amaranths (Am), reputedly rich in lysine (Lys) and tryptophan (Trp), but moderately deficient in leucine (Leu), should be ideal complements to Lys and Trp-poor, Leu-rich maize (M). Most animal studies confirm this. In children, 20, 30 and even 50 per cent replacement of M proteins with toasted Am proteins had failed to show any gains over M or Am alone: heat losses of Lys were suspected. Plasma obtained during the above studies, before and 3 h and 4 h after the first meal of the last day of consuming Am alone, three M-toasted Am mixtures, or M alone, were analysed for free AAs. Toasted, popped or flaked Am consumption caused significant p.p. falls in molar proportions of Leu from 99 to 85, 88 to 82, and 92 to 75, and of threonine (Thr) from 118 to 108 (popped) and 109 to 97 (flaked) mmol/mol TEAA, suggesting that these were first- and second-limiting EAAs. Post-prandial fall in Lys proportion was questionably significant. The M diet produced highly significant 3-h Leu elevation from 132 to 187, Lys fall from 167 to 135, and Trp fall from 62 to 46 mmol/mol TEAA.(ABSTRACT TRUNCATED AT 250 WORDS)

To ascertain that linear growth and weight gain continue while consuming a diet in which all the day's protein is given in one meal, six children (ages: 8.5 to 25 months, weight: 6 to 8 kg) who were convalescing from malnutrition were placed on such a diet for 60 to 67 days. All diets provided 125 to 150 kcal and 2.0 to 2.5 g protein/kg/day, recalculated weekly. Energy was evenly divided among five feedings but the entire day's protein was given at the third meal. Increases in height age relative to increases in chronological age were appropriate for the stage of recovery. Height quotient (height age/chronological age times 100) increased during the study in four children and remained constant in two. Increases in weight age were greater than corresponding increases in chronological age. Nine-day control periods prior to and after the growth study allowed comparative N balances, which confirmed previous findings that apparent N retention from the unevenly distributed protein (32 +/- 10% of intake) was less, although not significantly so, than that from the control diet (34 +/- 15% of intake). Fecal facts were elevated during the study period (18 +/- 7.5% of intake) relative to the control period values (9 +/- 3.9% of intake) in all but one child.

Two varieties of cassava, processed as Nigerian fermented flour (gari) or as Brazilian flour (farinha), were fed to two groups of eight infants and young children, each group receiving both forms of one variety, with preceding, intervening and following casein control diets. The flours provided 50% of diet energy, with casein added to make 8% energy as protein, vegetable oils to make 20% as fat and corn syrup solids and sugar to make 72% carbohydrate (CHO) energy. Fecal wet weight increased (P less than 0.05) from approximately 100 g/d (casein diets) to means (+/- SD) of 202 +/- 72, 171 +/- 58, 154 +/- 46 and 190 +/- 67 g/d; dry weights from means of 14.7-18.3 g/d to means of 22.9-24.4 g/d (P less than 0.05); fecal energy from means of 50-60 kcal/d to means of 89-94 kcal/d (P less than 0.01); fetal fat was generally not affected; and fecal CHO nearly tripled (P less than 0.01) from approximately 4 to 12 g/d. Apparent nitrogen absorptions and retentions from the cassava + casein diets were modestly lower than from casein diets. Rates of weight gain were very variable and not significantly different by diet; serum albumin levels were essentially unchanged. The results with these flours were indistinguishable from each other and from those previously found with freeze-dried cassava flour in otherwise identical diets. Variety and processing method had no effect on the digestibility of cassava starch and oligosaccharides and on the great resistance to digestion and the water-holding capacity of cassava fiber.

Infants consumed 75% of calories as 82% extraction wheat flour with satisfactory short-term protein and energy digestion. Protein needs, represented by N retentions from casein, probably were not satisfied. Long-term (3+ months) studies in four infants showed that 50% calories and 80% protein from wheat (casein added to 8% protein calories) supported weight gain and linear growth more than expected. Prolonged feeding of 75% calories and 100% protein from wheat attempted in three infants. In the oldest (15.5 months), digestibility and growth was satisfactory; in one, despite good digestion, weight gain and growth was inadequate and serum albumin fell until 0.2% lysine was added; and in another, weight gain was satisfactory but albumin fell to 3.25 g/dl and growth was inadequate. In six other infants, lysine addition during the 2nd of 3 months was associated with significant increase in N retention and weight gain and stabilization of albumin; lysine withdrawal resulted in significant decrease in weight gain with no effect on N retention or albumin; growth was barely adequate during 3-month study. Serum cholesterol fell only when dietary protein was inadequate. It is practically impossible for unsupplemented wheat to satisfy protein needs of infants and most small children.

The protein quality and digestibility of two high lysine (2.9-3.0 g/100 g protein) and tow conventional varieties (lysine content 2.1-2.2 g/100 g protein) of whole grain sorghum milled as flour were assessed through balance studies in 13 children 6-30 months of age. Sorghum protein provided 6.4 or 8.0% of dietary energy. Control diets contained 64% kcal protein as casein. Children consumed 100-150 kcal/kg body weight/day. Sorghum consumption was associated with weight loss or poor weight gain. We found no difference by variety in apparent nitrogen absorption or retention. Mean absorption and retention of nitrogen (+/- SD) from 26 six-day sorghum dietary periods were 46 +/- 17% and 14 +/- 10% of intake, respectively (corresponding preceding casein control values: 81 +/- 5% and 38 +/- 3%). Stool weight and energy losses during sorghum periods averaged 2.5 to 3 times control values. Plasma amino acids were determined in eleven children after 16 days of sorghum consumption. Fasting concentration of total amino acids (TAA) was similar to values previously obtained with wheat protein at similar levels of intake. Total concentration of essential amino acids (TEAA) was low as were concentrations of lysine (Lys) and threonine (Thr). Analysis of postprandial changes of the Lys/TEAA and Thr/TEAA molar ratios confirmed that Lys was the first limiting amino acid.

Whole grain sorghum flour was fermented into Nasha, a traditional Sudanese food, and freeze-dried or drum-dried. It was cooked and fed to convalescent malnourished infants and small children as 61% of total diet calories and all of 6.4% protein calories, with (Lys+) and without lysine supplementation to 3% of protein. Apparent absorptions of nitrogen were 73 +/- 5 and 74 +/- 6% of intake, significantly (P less than 0.01) less than those from preceding (Cas-1, 86 +/- 3%) and following (Cas-2, 85 +/- 3%) isonitrogenous casein diets. Apparent retentions of nitrogen from Nasha (26 +/- 10%) were significantly lower than those from Lys + (34 +/- 9%, P less than 0.05), Cas-1 (35 +/- 11%, P less than 0.01) or Cas-2 (49 +/- 9%, P less than 0.01). Retentions from Cas-2 were higher than those from Cas-1 or Lys + (P less than 0.01). Fecal wet and dry weights were higher (P less than 0.02) during both Nasha diets and Cas-2 than during Cas-1. Fecal energy and carbohydrate were significantly (P less than 0.01) higher from either Nasha diet than from either casein diet; fecal fat was not different. Two children received drum-dried Nasha without further cooking; digestibilities were not different from those of the cooked product but biological value was much lower. When properly cooked and consumed along with small amounts of a good source of lysine, Nasha is a satisfactory weaning food.

BLOOD GLUCOSE, INSULIN (IRI), growth hormone, and plasma free fatty acids (FFA) were determined in six children consuming a diet of uneven distribution of protein relative to energy (study period). Preprandial and postprandial samples surrounding the 8 AM protein-free feeding and the 3 PM feeding containing all the day's protein were compared with values obtained in the same children similarly sampled while consuming an isonitrogenous isoenergetic diet of even protein distribution (control period). After the 8 AM feeding during the study period there was a mean maximal rise of blood glucose at 30 min of 51 mg/dl compared with a rise of 16 mg/dl during the control period. Glucose remained significantly elevated above fasting values at 120 min during the study but not the control period. IRI response after the 8 AM feeding was significantly greater and suppression of FFA was more marked during the study than during the control period. Glucose concentration 30 min after the 3 PM feeding was significantly lower during the study period than during the control period. A peak value occurred at 60 min during the study period which was equal to the 30 min peak control value. Despite the slower elevation of blood glucose during the study period, IRI rose at 30 min, possibly related to a larger influx of amino acids from the protein-containing meal. FFA rose at 30 and 60 min and were then suppressed by the slowly rising blood glucose. Growth hormone after both meals while consuming both diets was variable but considered normal. The qualitative changes in glucose-IRI-FFA responses were for the most part attributable to differences in the test meals and suggested little long-term adaptation to the uneven protein distribution diet.

Amaranthus caudatus L. toasted flour, popped grain and flakes were each fed to nine young children as the source of all diet protein and fat and 50% of diet energy, preceded and followed by casein control diets. All provided 6.4-6.7% of energy as protein and 9.3-10.1% as fat. Balances were carried out during the last 6 d of the three 9-d amaranth periods and during the four control periods. Fecal wet and dry weights during amaranth diets were 129-157% of those during casein control diets; fecal energy, fat and carbohydrate from the toasted flour periods were 193, 268 and 256%; from the popped grain 253, 586 and 195%; and from the flakes 225, 356 and 255% of those during casein diets. Apparent N absorptions were 84.1-84.6% of the casein values (P less than 0.001); apparent retentions from toasted, popped and flaked amaranth were 70.9, 65.9 and 59.0% of casein (P less than 0.001). The last of these was significantly lower than the first (P less than 0.05). Fecal fat was much higher (P less than 0.001) from the popped than from the flaked grain and the toasted flour. Toasted flour was then added to maize meal so that amaranth provided 20 or 30% of the protein. Seven young children received diets in which 6.4% of total energy came from one of the above mixes, or from casein, as protein. Soya-cottonseed oils completed 25% lipid energy in all three diets; balance of energy was from sucrose in the experimental diets and from sucrose, corn syrup solids and cornstarch in the casein diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Fasting and postprandial plasma free amino acids were studied in nine children on the 9th day of consumption of a diet in which potato protein provided all nitrogen at a marginal level of protein intake (5.03-5.10% protein-calories). The analysis of the potato utilized indicated that 49% of total amino acids (TAA) were free amino acids (AA) and 40% essential amino acids (EAA). Fasting values of TAA and total essential amino acids (TEAA) and the ratios of EAA/TEAA were similar to those obtained previously with milk or casein diets. The low percentage of protein-calories in the diet and relatively poor nitrogen absorption of the potato were reflected in a low (0.236) fasting TEAA/TAA ratio. Met/TEAA and Trp/TEAA ratios were significantly (P less than 0.05) but not markedly lower 3 hours postprandially compared to fasting values, returning to the initial levels 4 hours postprandially. Thr/TEAA ratio was significantly higher (p less than 0.05) at 3 hours but not so at 4 hours. The results suggest that potato protein has an adequate ratio of TEAA/TAA and the balance among individual EAA concentrations should be able to meet the EAA requirements of growing infants and small children if fed and absorbed in sufficient amounts to meet total nitrogen needs.

To determine whether increasing proportions of cassava could be consumed and satisfactorily digested, eight recovering malnourished children (20-38 mo old) received 25, 50 and 75% of their diet energy as freeze-dried cassava flour during 9-d periods, with intervening casein control diets. Enough casein was added to all cassava diets to bring protein energy to 8% of the total. When compared to the control diet, the 25% diet had no significant effect on consumption time or measures of protein and energy digestion. With the 50% diet, fecal wet and dry weights were moderately higher than with the 25% diet (196 +/- 44 and 24 +/- 4 vs. 121 +/- 36 and 16 +/- 3 g/d, respectively), as were fecal energy (89 +/- 16 vs. 63 +/- 16 kcal/d) and calculated carbohydrate (11 +/- 2 vs. 5 +/- 1 g/d); apparent nitrogen absorption (mostly from casein) was slightly lower (79 +/- 5 vs. 83 +/- 6%) and consumption time slightly higher (5-25, median 10, vs. 4-18, median 6 min/feeding). When energy from cassava was increased to 75%, fecal weights (240 +/- 49 and 31 +/- 5 g/d), energy (124 +/- 27 kcal/d) and carbohydrate (16 +/- 4 g/d) were all higher than when cassava provided 50 or 25% of energy. Consumption required 8-34, median 17 min/feeding and apparent nitrogen absorption was 76 +/- 6% of intake.(ABSTRACT TRUNCATED AT 250 WORDS)

The quality of the protein in a complete tube feeding formula intended for use in adults was evaluated in convalescent malnourished children. The casein-soy protein isolate blend was found to be similar to casein by comparative nitrogen balance studies carried out in five children, with protein providing 6.4% of calories. Three- and four-hour postprandial plasma free amino acid determinations at the same level of protein intake did not show the drop of plasma free methionine or of the methionine/total essential amino acid molar fraction characteristically seen when this amino acid is first limiting for protein synthesis. Three additional children were fed the formula, altered only by the addition of water, for periods of up to 3.6 months to test the tolerance to and completeness of the diet. No untoward effects nor signs of specific nutrient deficiency were encountered. Linear growth was appropriate for the stage of recuperation. The failure to achieve a normal (greater than 3.8 g/dl) serum albumin concentration in two of the three children may have been due to their rapid weight gain. Although it is intended for the adult, our results indicate that the formula could meet the nutritional requirements of infants and children.

The opaque-2 (o2) gene increases the lysine and tryptophan contents of maize and its protein quality; the sugary-2 (su2) gene improves vitreousness and density but decreases lysine; the double-mutant surgery-2 opaque-2 (su2o2) has the improved kernel characteristics and an even higher protein quality than opaque-2. Digestibility of energy and protein, and protein quality of normal, o2 and su2o2, both as endosperm (E) and whole kernel (WK) meals, were studied in eight convalescent malnourished children, 10--25 months of age. Diets provided 100--125 kcal/kg/day, 10% fat, with all of 6.4% protein calories from one of six maize meals or casein. Endosperm meals provided 83.2, 91.2 and 82.1% of energy, WK meals 73.2, 68.6 and 67.2% of energy in respective diets. Apparent N retention from E meals was lower than from WK meals, both lower than from casein. For each type of meal (E and WK) there was strong correlation between lysine "absorbed" and N retention, but this was higher from WK at equal lysine intakes. For 50% of children to match N retention from casein, presumably equal to requirement, they would have to consume 203.9, 148 or 122.5% of energy requirement as normal, o2 or su2o2 E meals, obviously impossible. For WK meals, they would have to consume 108.2, 90.3 or 84.2% of energy as normal, o2 or su2o2.

The opaque-2 gene was shown years ago to increase the nitrogen, lysine, and tryptophan contents of maize and to markedly increase its nutritional value for small children. Concerns about decreased yield, resistance, and acceptability discouraged further development of the gene. Quality protein maize, while retaining the opaque-2 characteristics, has overcome those constraints. Six recovering malnourished infants received diets in which all of the 6.4% protein energy was supplied by casein, quality protein maize, or common maize. The quality protein maize supplied 60% and common maize 75% of total energy. Vegetable oil was added to increase fat contents to 10% of total energy in all diets. Energy digestibility was less (87% and 84%) from quality protein maize and common maize than from casein diets (94%); most of the difference was due to carbohydrate digestibility. Apparent N absorptions from quality protein maize (70 +/- 5%) and common maize (69% +/- 7%) were much lower (P less than .01) than from casein (82% +/- 4%). Apparent retention of N from quality protein maize (34 +/- 4%) was less (P less than .01) than from casein (41% +/- 9%) but greater (P less than .01) than from common maize (22% +/- 10%). Breath hydrogen excretions were usually greater during quality protein maize consumption than during casein diets but not nearly as much as those during common maize diets. The nutritional advantages of quality protein maize v common maize are of a magnitude that must be exploited for the advantage of children in maize-consuming poor countries.

Blood sugar and plasma free fatty acids (FFA), immunoreactive insulin (IRI), and growth hormone (GH) responses to a protein-glucose meal were determined in normal infants and those with marasmus and marasmic kwashiorkor. Among the normal subjects, fasting blood sugar (BS), peak BS and IRI, and the IRI/BS ratio tended to decrease as age increased. Peak IRI was at least 13muU/ml above fasting in 21 of 24 infants. Fasting GH levels were high 38.5 +/- 13.6 (SD) and 26.3 +/- 14.0 ng/ml, in the two youngest groups (under 1 year) and were comparable with those of the late newborn period. They were slightly lower, 20.8 +/- 22.1, in those 12.5-18.5 months of age. Suppressions of FFA and subsequent rebounds were in close temporal relation to BS and IRI peaks and lows, but not the GH levels. GH was promptly suppressed by the meal, and in most infants secondary elevations were seen. Untreated marasmic infants had normal or low BS, correspondingly normal or low IRI, markedly elevated FFA (1,821 +/- 588 muEq/liter), and GH levels comparable with those of the control subjects. There was some delay in BS elevation and disappearance and poor insulin release after the meal, with only two of nine having elevations of at least 13 muU /ml The BS elevations and IRI responses, however, were adequate to block FFA release. GH levels were poorly suppressed by the meal but some infants had further elevations, possibly in response to protein. After partial rehabilitation, fasting BS and FFA and BS elevations after the meal were normal. A slight improvement in insulin release was apparent. Fasting GH levels and responses to the meal were normal. Fasting, minimally treated children with marasmic kwashiorkor (MK) had normal or low BS, normal or low IRI, normal FFA, and probably normal GH levels. There was considerable delay in BS elevation, moderately delayed glucose disappearance, and very poor or unmeasurable insulin release after the test meal; FFA and GH were poorly suppressed. After partial rehabilitation, fasting BS was normal, FFA levels were (630 +/- 163 muEq/l), IRI was still low, BS elevations and disappearance improved. IRI responses modestly improved, and GH responses were normal.

The quantity and quality of protein in the diet affect both nitrogen balance and energy utilization in man. One possible mechanism is by a direct effect on the process of fat digestion and absorption. The effect on fat absorption of feeding diets providing 0%, 6.4%, or 12.5% of energy as protein was assessed in nine children. Liquid diets were prepared by high speed blending of calcium caseinate, a soy-cottonsed oil blend (80:20), sucrose, water, vitamins, and a mineral mixture and fed by bottle five times per day. Diets varied in the amount of protein and were fed to maintain constant the intakes of fat and carbohydrate. All children began by consuming the diet providing 6.4% of energy as protein for a period of 6 days: 3 days of adaptation, 3-day dietary periods and metabolic collections followed in one of two sequences: 12.5%, 0%, 6.4% energy as protein in five children; 0%, 12.5%, 6.4% energy as protein in four. Mean fat excretion during the two 6.4% periods did not differ significantly (initial 14.5 +/- 6% of intake; final, 11.7 +/- 5.0% of intake). Fat excretion was significantly greater during the period when no protein was consumed (23.9 +/- 7.7% of intake) than during either the period in which protein provided 6.4% of energy (P less than 0.01) or during that in which protein provided 12.5% of energy (10.0 +/- 2.6% of intake, P less than 0.001). The difference between the 6.4% and 12.5% periods did not attain significance (P = 0.10). Fecal fat expressed as a percentage of fecal dry weight was significantly greater during periods when the diet contained no protein than during periods in which protein provided either 6.4% (P less than 0.05) or 12.5% (P less than 0.01) of energy. Additional studies were carried out in a similar fashion in six children consuming diets in which protein provided 5%, 9.6%, and 15% of energy. All six possible dietary sequences were used. At these intakes fat excretion did not vary significantly with protein intake.

The digestibility and protein quality of the white potato were studied in 11 infants, ages 8-35 months, recovering from malnutrition. Seven 9-day dietary periods comprised the study. Digestibility was assessed by metabolic balance during the last 6 days of dietary periods in which potato provided 25%, 50% or 75% of dietary energy. Casein-based control dietary periods preceded and/or followed each potato dietary period. Fecal wet and dry weights, fecal energy, computed fecal carbohydrate and fecal fat during consumption of the 25% potato diet did not differ from control. Analysis of variance showed that consumption of increasing amounts of potatoes produced a significant linear increase in all parameters of digestibility except fecal fat. Fecal wet weight and energy content during the 75% potato period were more than double control values. Regression analysis of data from potato dietary periods showed fecal wet weight to be an excellent predictor of fecal dry weight (r = 0.904), energy content (r = 0.785) and computed fecal carbohydrate (r = 0.770). Protein quality of potato was assessed with N balance studies during the dietary periods in which potato provided all dietary protein (approximately 5% protein kcal). Apparent N retention was 78% of that from an isonitrogenous casein control diet. Decreased apparent N absorption was primarily responsible for the difference; the "biologic value" (percent of absorbed N that was retained) was similar for both diets.

The optimisation of nutritional support for the growing number of older individuals does not usually take into account medication. Paracetamol (acetaminophen; APAP) is the first intention treatment of chronic pain that is highly prevalent and persistent in the elderly. Detoxification of APAP occurs in the liver and utilises sulfate and glutathione (GSH), both of which are issued from cysteine (Cys), a conditionally indispensable amino acid. The detoxification-induced siphoning of Cys could reduce the availability of Cys for skeletal muscle. Consequently, APAP could worsen sarcopenia, an important component of the frailty syndrome leading to dependency. The present review provides the rationale for the potential pro-sarcopenic effect of APAP then recent results concerning the effect of chronic APAP treatment on muscle mass and metabolism are discussed. The principal findings are that chronic treatments with doses of APAP comparable with the maximum posology for humans can increase the requirement for sulfur amino acids (SAA), reduce Cys availability for muscle, reduce muscle protein synthesis and aggravate sarcopenia in animals. One clinical study is in favour of an enhanced SAA requirement in the older individual under chronic treatment with APAP. Few clinical studies investigated the effect of chronic treatment with APAP combined with exercise, in nutritional conditions that probably did not affect Cys and GSH homeostasis. Whether APAP can aggravate sarcopenia in older individuals with low protein intake remains to be tested. If true, nutritional strategies based on enhancing Cys supply could be of prime interest to cut down the pro-sarcopenic effect of chronic treatment with APAP. [ABSTRACT FROM AUTHOR]

Child growth stunting is common in low-income countries, possibly due to insufficient protein intakes. Most previous studies have concluded that children's protein intakes are adequate in relation to estimated requirements, but these studies did not consider issues of protein digestibility and effects of infection on dietary protein utilization. Using an alternative approach to assess the possible role of protein inadequacy in children's growth restriction, the results of 18 intervention trials in which supplementary protein or amino acids were provided to children ages 6-35months and growth outcomes were reviewed. Eight studies conducted in hospitalized children recovering from acute malnutrition found that the recommended protein intake levels for healthy children supported normal growth rates, but higher intakes were needed for accelerated rates of "catch-up" growth. Ten community-based studies did not demonstrate a consistent benefit of supplemental protein on children's growth. However, weaknesses in the study designs limit the conclusions that can be drawn from these studies, and additional appropriately designed trials are needed to answer this question definitively. Recommendations for optimizing future study designs are provided herein. [ABSTRACT FROM AUTHOR]

As the leading cereal crop in the world, corn ( Zea mays L.) plays a significant role in human foods. The focus of this review is on the structures, properties, bioavailability, and health benefits of macronutrients in corn, including its starch, nonstarch polysaccharides, protein, and lipids. With a large number of naturally existent mutants, corn and corn-based food ingredients with varying macronutrient compositions and different chemical structures and physical properties are commercially available. The corn varieties that have attracted the most interest in human nutrition include high-amylose, high-protein, and high-oil corn. Chemical compositions and molecular structures of starch, nonstarch polysaccharides, protein, and lipids from different corn varieties are comprehensively reviewed here and related to their physical properties, bioavailability, and physiological effects on human health. Particular emphasis is placed upon the impacts of high-amylose corn flour/starch on postprandial glycemic/insulinemic responses, insulin sensitivity, satiety/appetite, lipid metabolism/obesity, colon health, and mineral absorption. The information presented in this article will be useful for the utilization of corn and the development of corn-based food ingredients to prepare nutritious food products to improve human health. [ABSTRACT FROM AUTHOR]

Aim: To test the hypotheses that body size is reduced and body composition altered in preterm infants at hospital discharge. Methods: Preterm infants (≤34 weeks gestation, ≤1750 g at birth) were enrolled. Body weight, length and head circumference were converted to standard deviation or z-scores. Body composition was measured using dual emission X-ray absorptiometry. The results were analysed using standard statistics. Results: One hundred and forty-nine infants (birth weight = 1406 ± 248 g, gestation = 31 ± 1.7 weeks) were studied. Postmenstrual age at discharge was 37 ± 1.2 weeks. Z-scores for head circumference, weight and length differed (−0.1 ± 0.6 > −1.4 ± 0.6 > −1.9 ± 0.6; p < 0.0001). Global fat-free mass was less in study infants than the reference infant at the same weight (2062 < 2252 g; p < 0.0001) or gestation (2062 < 2667 g; p < 0.0001). Global fat mass was greater in study infants than the reference infant at the same weight (307 > 198 g, 13 > 8%) or gestation (307 > 273 g; 13 > 9%; p < 0.0001). Changes in central fat mass closely paralleled those in global fat mass (r2 = 0.76, p < 0.0001). Conclusion: Reduced linear growth and a reduced fat-free mass suggest that dietary protein needs were not met before discharge. A reduced fat-free mass coupled with an increased global and central fat mass echoes concerns about the development of insulin resistance and metabolic syndrome X in these high-risk infants. [ABSTRACT FROM AUTHOR]

ObjectiveTo estimate the energy requirements of infants from total energy expenditure and energy deposition during growth.DesignEnergy requirements during infancy were estimated from total energy expenditure measured by the doubly labelled water method and energy deposition based on measured protein and fat gains.SettingDatabase on the total energy expenditure and energy deposition of infants was compiled from available studies conducted in China, Chile, Gambia, Mexico, Netherlands, UK, and USA.SubjectsHealthy, term infants.ResultsTotal energy requirements (kJ day−1) increased with age and were higher in boys than girls due to differences in weight. Energy requirements decreased from 473 kJ kg−1 per day for boys and 447 kJ kg−1 per day for girls at 1 month of age to 337 kJ kg−1 per day for boys and 341 kJ kg−1 per day for girls at 6 months of age, and thereafter tended to plateau. Energy deposition as a percentage of total energy requirements decreased from 40% at 1 month to 3% at 12 months of age. These estimates are 10–32% lower than the 1985 FAO/WHO/UNU recommendations which were based on observed energy intakes of infants.ConclusionsRecommendations for the energy intake of infants should be revised based on new estimates of total energy expenditure and energy deposition. [ABSTRACT FROM AUTHOR]

Presents a discussion of the recommendations for protein intake among British children. British National Diet and Nutrition's description of the diet of a representative sample of children; Publication and comparison with the results of an American survey on the reference nutrient intakes.