PEDIATRICS Vol. 97 No. 4 April 1996, pp. 499-505
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Protein Requirements of Infants and Children: Growth During Recovery From Malnutrition

George G. Graham MD1, William C. MacLean Jr MD2, Kenneth H. Brown MD3, Enrique Morales MD1, Jorge Lembcke MD1, and Arturo Gastañaduy MD4

1 Instituto de Investigación Nutrucional (IIN), Apartado 18-0191, Lima 18, Perú and the Johns Hopkins Medical Institufions, Baltimore, Maryland
2 Instituto de Investigación Nutrucional (IIN), Apartado 18-0191, Lima 18, Perú and the Johns Hopkins Medical Institufions, Baltimore, Maryland; Pediatric Nutrition Research and Development, Ross Laboratories, Columbus, OH 43215
3 Instituto de Investigación Nutrucional (IIN), Apartado 18-0191, Lima 18, Perú and the Johns Hopkins Medical Institufions, Baltimore, Maryland; Program in International Nutrition, Department of Nutrition, University of California, Davis, CA 95616
4 Instituto de Investigación Nutrucional (IIN), Apartado 18-0191, Lima 18, Perú and the Johns Hopkins Medical Institufions, Baltimore, Maryland; Department of Pediatrics, School of Medicine, Louinsiana State University, New Orleans, LA 70112

Address correspondence to: George C. Graham, MD, P.O Box 205, Gibson Island, MD 21056

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 ± 14 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 (Sgr 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%. Sgr 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 · Kg-1 · d-1 for toddlers, should still be safe for nearly all children of comparable biological ages.

Submitted on November 21, 1994
Accepted on May 31, 1995




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