Energy Balance and Nitrogen Balance in Growing Low Birthweight Infants Fed Human Milk or Formula

Whyte, Robin; Haslam, Richard J.; Vlainic, Carol; Shannon, Sue; Samulski, K; Campbell, Dugal; Bayley, H. S.; Sinclair, John C.

doi:10.1203/00006450-198311000-00011

Cited by 72 publications

(34 citation statements)

References 8 publications

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“…They compare with the higher range of reported values (20,(23)(24)(25)(26)(27)(28). The composition of weight gain in premature babies is the object of daily clinical concerns in the neonatal units.…”

Section: Nutrient Balance and Composition Of Weight Gainsupporting

confidence: 48%

“…A number of practical considerations preclude the utilization of methods like body density or K-40 measurements to get this information. Therefore bedside, noninvasive methods have to be used and a limited number of investigations have been performed ENERGY METABOLISM IN PREMATURE INFANTS (6,21,23,29,30). The measured protein gain as well as the rate of weight gain are comparable to the studies using different milk formulas and different levels of energy intakes (6,23,29,30).…”

Section: Nutrient Balance and Composition Of Weight Gainmentioning

confidence: 64%

“…The comparison between the studied premature babies and fetuses of the same age is interesting, even if there is little rationale to do so. Their growth, in terms of weight gain and protein gain is comparable, whereas their fat gain differs (23,29,30). The premature infants' fat accumulation is higher than intrauterine values at the comparable postconceptional age and lower than that of term babies at a comparable postnatal age.…”

Section: Nutrient Balance and Composition Of Weight Gainmentioning

confidence: 76%

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Energy Balance, Physical Activity, and Thermogenic Effect of Feeding in Premature Infants

et al. 1986

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ABSTRACT. In order to assess the contribution of the thermogenic effect of feeding and muscular activity to total energy expenditure, nine premature infants were studied for 2 consecutive days during which time repeated measurements of energy expenditure by indirect calorimetry were performed throughout the day, combined with a visual activity score based on body movement. The infants were growing at 16.6 f 4.0 g/kg/day (mean f SD) and received 110 + 8 kcal/kg/day metabolizable energy (milk formula) and 522 + 40 mg N/kg/day. Their total energy expenditure was 68 f 4 kcal/kg/day indicating that 41 2 7 kcal/kg/day was retained for growth. Based on the combination of energy + N balances it was estimated that 80% of the weight gain was fat-free tissue and 20% was fat tissue. The rate of energy expenditure measured minute-by-minute was significantly and linearly correlated with the activity score in both the premeal ( r = 0.75; p < 0.001) and the postmeal periods ( r = 0.74; p < 0.001) with no difference in the regression slope, but with a significant difference in intercept. In preset feeding schedules the latter allowed an estimation of the thermogenic effect without the confounding effect of activity. This was found to be 3.1 + 1.8% when expressed as a percentage of metabolizable energy intake. However when the "classical" approach was used as a comparison (integretation of extra energy expenditure induced by the meal), the thermogenic effect was found to be greater, i.e. 9.5 + 3.8% of the meal's metabolizable energy, due to the superimposed effect of physical activity in the postprandial state. The study suggests that the intradaily variation in energy expenditure in premature infants nursed according to present day techniques is almost equally due to the thermogenic effect of feeding (3.2 kcal/kg/day), and to variations in muscular activity (3.6 kcal/kg/day) both representing a small fraction of the total energy expenditure in premature infants (i.e. 4.7 and 5.3%, respectively). This work was supported by a research grant from NestlC, Vevey Switzerland. 6ing and feeding, the study of energy metabolism in preterm infants has progressed at a rapid pace. However, measurements of energy expenditure in premature babies have been generally of short duration (5, 7-9), i.e. approximately 1-3 h. Therefore the extent to which these limited periods of measurement can be extrapolated to 24 h is still uncertain. When energy expenditure of preterm infants is continuously monitored over 24 h (6), the variability of measurements generally observed is mainly due to two factors: variations in physical activity (i.e. whole body movements, crying), and the thermogenic response to feeding. Although several methods have been developed to score changes in spontaneous physical activity of infants (7, 9-16), it is not known to what extent these scores are related to the rate of energy expenditure. Because the thermogenic response itself can be influenced by several factors such as duration of measurement, feeding frequency, size and typ...

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Section: Nutrient Balance and Composition Of Weight Gainsupporting

confidence: 48%

Section: Nutrient Balance and Composition Of Weight Gainmentioning

confidence: 64%

Section: Nutrient Balance and Composition Of Weight Gainmentioning

confidence: 76%

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Energy Balance, Physical Activity, and Thermogenic Effect of Feeding in Premature Infants

et al. 1986

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“…The American Academy of Pediatrics has suggested that a logical goal for nutritional support of the preterm LBW infant is to achieve postnatal growth approximating that of a normal fetus of the same postconceptional age (1,2). Attempts to achieve this goal by feeding enriched diets have been successful in supporting the intrauterine rate of weight gain (3)(4)(5)(6)(7), but invariably these diets lead to a disproportionate increase in body fat. The reasons for this postnatal failure to maintain the high fetal rates of protein accretion relative to fat deposition are unknown.…”

mentioning

confidence: 99%

Effects of Quality of Energy Intake on Growth and Metabolic Response of Enterally Fed Low-Birth-Weight Infants

et al. 2001

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Carbohydrate and fat may vary in their ability to support protein accretion and growth. If so, variations in the source of nonprotein energy might be used to therapeutic advantage in enterally fed low-birth-weight infants. To test the hypothesis that high-carbohydrate diets are more effective than isocaloric highfat diets in promoting growth and protein accretion, low-birthweight infants weighing 750 -1600 g at birth were randomized in a double blind study to receive one of five formulas differing only in the quantity and quality of nonprotein energy. Groups 1, 2, and control received 130 kcal·kg -1 ·d -1 with 35, 65, and 50% of the nonprotein energy as carbohydrate. Groups 3 and 4 received energy intake of 155 kcal·kg -1 ·d -1 with 35 and 65% of the nonprotein energy as carbohydrate. Protein intake of all groups was 4 g·kg -1 ·d -1 . Growth and metabolic responses were followed weekly, and macronutrient balances including 6-h indirect calorimetry were performed biweekly. Greater rates of weight gain and nitrogen retention were observed at high-carbohydrate intake compared with high-fat intake at both gross energy intakes. Greater rates of energy storage and an increase in skinfold thickness were observed in group 4 (high-energy highcarbohydrate diet) despite higher rates of energy expenditure. These data support the hypothesis that at isocaloric intakes, carbohydrate is more effective than fat in enhancing growth and protein accretion in enterally fed low-birth-weight infants. However, a diet with high-energy and high-carbohydrate content also results in increased fat deposition. The American Academy of Pediatrics has suggested that a logical goal for nutritional support of the preterm LBW infant is to achieve postnatal growth approximating that of a normal fetus of the same postconceptional age (1, 2). Attempts to achieve this goal by feeding enriched diets have been successful in supporting the intrauterine rate of weight gain (3-7), but invariably these diets lead to a disproportionate increase in body fat. The reasons for this postnatal failure to maintain the high fetal rates of protein accretion relative to fat deposition are unknown. One difference between fetal and neonatal life is the relatively greater dependence of the fetus on carbohydrate versus fat as an energy source. If the fetus is relatively more dependent on carbohydrate than fat, then it is possible that the same is true of the fetus ex utero, i.e. the preterm LBW infant. This reintroduces a question of long-standing concern in developmental nutrition, namely, do carbohydrate and fat differ in some fundamental way in their ability to support protein synthesis? Indeed, there is experimental evidence that supports the hypothesis that calorie for calorie, utilization of carbohydrate as an energy source is more effective than fat in supporting protein accretion (8 -11); other research, however, asserts that this effect is transient (12). In enterally fed LBW infants, this hypothesis remains untested.LBW infants are ideal subjects for studying th...

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“…(Pediatr Res 35: [704][705][706][707][708][709][710][711][712]1994) Abbreviations LBW, low birth weight Current guidelines for feeding LBW infants stress the importance of achieving as soon after birth as possible a rate of weight gain that is at least equal to or, preferably, greater than the intrauterine rate (1, 2). A number of studies have demonstrated that even the higher rates of weight gain can easily be achieved but that the accompanying rates of fat accretion are as much as 3-fold greater than the intrauterine rate (3)(4)(5)(6)(7)(8). The desirability of such high rates of fat accretion are unknown.…”

mentioning

confidence: 99%

Evaluation of a Mathematical Model for Predicting the Relationship between Protein and Energy Intakes of Low-Birth-Weight Infants and the Rate and Composition of Weight Gain

et al. 1994

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ABSTRACT'. A model for predicting the relationship between protein and energy intakes of low-birth-weight (LBW) infants and the rate and composition of weight gain is described. It is based on linear multiple regression equations summarizing the rates of weight gain, nitrogen retention, and energy retention of 101 previously studied LBW infants fed protein intakes ranging from 2.25 to 3.9 g. kg-' .d-' and concomitant energy intakes ranging from 115 to 147 kcal. kg-'.d-' plus current theory concerning nutrient retention and body composition. To test the validity of the model, three combinations of protein and energy intake predicted by the model to result in specific rates and compositions of weight gain were fed to 44 LBW infants, and the observed rates of weight gain, protein accretion, and fat accretion were compared with the rates predicted by the model. Differences in these and other outcome variables between two of the groups, the intakes of which differed only in energy, also were compared to provide additional insight into the effect of concomitant energy intake on protein utilization. Across groups, actual outcomes correlated closely with predicted outcomes, supporting the validity of the model for the total population. However, outcomes of individual infants deviated as much as 30% from predicted outcomes; the magnitude of the deviation was independent of birth weight, gestational age, or size for gestational age. In addition, the mean rate of protein accretion of the group fed the highest protein/ energy ratio was significantly less than predicted. The higher mean urinary nitrogen excretion as well as blood urea nitrogen and plasma amino acid concentrations of this group versus the group that received a similar protein intake with a higher energy intake suggest that the higher energy intake improved nitrogen utilization. In toto, the data support the concept that the rate and composition of weight gain of LBW infants can be manipulated by intake; however, for individual infants, the extent of manipulation seems to be dependent on as-yet-unidentified inherent biologic variables. (Pediatr Res 35: [704][705][706][707][708][709][710][711][712] 1994) Abbreviations LBW, low birth weight Current guidelines for feeding LBW infants stress the importance of achieving as soon after birth as possible a rate of weight gain that is at least equal to or, preferably, greater than the intrauterine rate (1, 2). A number of studies have demonstrated that even the higher rates of weight gain can easily be achieved but that the accompanying rates of fat accretion are as much as 3-fold greater than the intrauterine rate (3-8). The desirability of such high rates of fat accretion are unknown. For most populations, they are considered undesirable, but this may not be true for the LBW infant who is born with limited fat stores. Moreover. approximately 40% of the weight gained by term infants over the first 4 mo of life appears to be fat (9), raising the possibility that high rates of fat accretion are unavoidable during ear...

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Energy Balance and Nitrogen Balance in Growing Low Birthweight Infants Fed Human Milk or Formula

Cited by 72 publications

References 8 publications

Energy Balance, Physical Activity, and Thermogenic Effect of Feeding in Premature Infants

Energy Balance, Physical Activity, and Thermogenic Effect of Feeding in Premature Infants

Effects of Quality of Energy Intake on Growth and Metabolic Response of Enterally Fed Low-Birth-Weight Infants

Evaluation of a Mathematical Model for Predicting the Relationship between Protein and Energy Intakes of Low-Birth-Weight Infants and the Rate and Composition of Weight Gain

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