Metabolic Cost of Growth in Very Low-Birth-Weight Infants

Gudinchet, F.; Schütz, Y.; Micheli, Jean-Léopold; Stettler, Eric; Jéquier, E

doi:10.1203/00006450-198212000-00012

Cited by 64 publications

(38 citation statements)

References 13 publications

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“…Gudinchet et al (4) measured vO, every 5 min for 24 h in three infants; the coefficients of variation were 3.5 to 6.6%. They concluded that nleasurements as brief as 1.5 h would be adequate to predict 24-h VOz.…”

Section: Resultsmentioning

confidence: 99%

Estimation of 24-Hour Energy Expenditure from Shorter Measurement Periods in Premature Infants

1986

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ABSTRACT. We performed continuous indirect calorimetry for 24 h on nine occasions in small premature infants. Oxygen consumption, carbon dioxide production, respiratory quotient, and energy expenditure were calculated for each 2-h period. The mean energy expenditure during the first 6 h was within 6.5% of the mean for the whole 24-h period in all but one case. The mean error in estimating total daily energy expenditure from 6-h measurements was 0.9%. Because positive and negative errors tend to offset each other, we also calculated the mean absolute error, which was 5.6%. The mean coefficient of variation in energy expenditure among the 2-h periods was 11.0%. The mean coefficients of variation in oxygen consumption, carbon dioxide production, and respiratory quotient were 12.8, 9.9, and 14.1%, respectively. Total daily energy expenditure of small premature infants can be estimated from measurements as short as 6 h with sufficient accuracy for most purposes. (Pediatr Res 20: [646][647][648][649] 1986) Abbreviations vOq, oxygen consumption vC02, carbon dioxide production RQ, respiratory quotient In order to learn more about growth of infants, it is important to understand how dietary energy is utilized. Ingested energy that is not excreted in the feces or urine is either expended for metabolism or stored in body tissues (l,2). By measuring energy intake, excretion, and expenditure it is possible to calculate the energy stored in the body during growth. Relating the energy stored to the rate of weight gain provides insight into the composition of new tissues during growth; fat contains a higher concentration of energy than nonfat tissues.Energy intake and excretion can be determined by collecting and analyzing aliquots of diet and excreta during balance studies of at least several days. Energy expenditure, however, is considerably more difficult to measure, and few attempts have been made to measure energy expenditure of infants for periods of 24 h or longer (3-6). More frequently, 24-h energy expenditure has been estimated from indirect calorimetry of shorter duration, usually periods of 6 h or less (7-1 3).In adults, 24-h energy expenditure cannot be accurately predicted from brief measurement periods due to the influences of Received November 26, 1985; accepted March 4, 1986. Correspondence and reprint requests to Edward F. Bell, M.D., Department of Pediatrics, University of Iowa, Iowa City, IA 52242.This work was supported by grants from the National Institutes of Health (HD16974, HD07578, RR00059) and the March of Dimes Birth Defects Foundation (6-356), and by a grant-in-aid from Gerber Products Company. activity, sleep, and meals on energy expenditure (14, 15). Moreover, it is not possible to perform calorimetric studies of adult subjects during their normal range of activities (14). On the other hand, premature newborn infants are fed frequently at regular intervals, sleep much ofthe time, and are relatively inactive when awake.For these reasons it is possible, although difficult, to perform continuous in...

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Section: Resultsmentioning

confidence: 99%

Estimation of 24-Hour Energy Expenditure from Shorter Measurement Periods in Premature Infants

1986

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“…A previously described, open circuit indirect calorimeter was used to measure energy expenditure (5). Briefly the calorimeter consists of an airtight perspex box, containing the whole infant, placed inside the incubator.…”

Section: Methodsmentioning

confidence: 99%

“…However, measurements of energy expenditure in premature babies have been generally of short duration (5,(7)(8)(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.…”

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confidence: 99%

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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“…Thus, in normal conditions, lipids deposited in adipose tissue are mainly of dietary origin. (4) The energy expended synthesising new tissue components arises in part from fat oxidation (Gudinchet et al, 1982). (5) There is an oxidation of fat related to physical activity (Bielinski et al, 1985) particularly in exercise of long duration and moderate intensity as is encountered in young children.…”

Section: Introductionmentioning

confidence: 99%

High fat versus high carbohydrate nutritional supplementation: a one year trial in stunted rural Gambian children

1998

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Objective: The study tests the hypothesis that a low daily fat intake may induce a negative fat balance and impair catch-up growth in stunted children between 3 and 9 y of age. Design: Randomized case-control study. Setting: Three rural villages of the West Kiang District, The Gambia. Subjects: Three groups of 30 stunted but not wasted children (height for age z-score 72.0, weight for height zscore ! 7 2.0) 3±9 y of age were selected by anthropometric survey. Groups were matched for age, sex, village, degree of stunting and season. Intervention: Two groups were randomly assigned to be supplemented ®ve days a week for one year with either a high fat (n 29) or a high carbohydrate biscuit (n 30) each containing approximately 1600 kJ. The third group was a non supplemented control group (n 29). Growth, nutritional status, dietary intake, resting energy expenditure and morbidity were compared. Results: Neither the high fat nor the high carbohydrate supplement had an effect on weight or height gain. The high fat supplement did slightly increase adipose tissue mass. There was no effect of supplementation on resting energy expenditure or morbidity. In addition, the annual growth rate was not associated with a morbidity score. Conclusions: Results show that neither a high fat nor a high carbohydrate supplement given during 12 months to stunted Gambian children induced catch-up growth. The authors suggest that an adverse effect of the environment on catch-up growth persists despite the nutritional interventions. Sponsorship: Nestle Â Foundation for the Study of the Problems of Nutrition in the World, Lausanne, Switzerland. Descriptors: stunting; dietary fats; dietary carbohydrates; nutritional supplementation; catch-up growth; energy intake; resting energy expenditure; morbidity IntroductionIn 1983 the prevalence of stunting in children under ®ve years of age in developing countries was estimated using national prevalence values at approximately 40%, yielding a total of 125 million children (Keller, 1988). Ten years later, in a recent WHO report on child growth, the prevalence was estimated at 43% and a total of 230 million children were identi®ed as being stunted (de Onis et al, 1993). These ®gures illustrate the magnitude of the problem of stunting and serve as a reminder of how little is known about its causes in nutritional, metabolic and biochemical terms.Despite access to medical care, young children in Keneba (West Kiang District, Gambia) have repeated infectious episodes with growth faltering followed by inadequate catch-up growth (Rowland et al, 1977). Children gradually become stunted during the ®rst two years of life and tend to remain stunted through childhood into adult life. There is however evidence that stunting can be reversed during infancy and even during late childhood through adoption and to a lesser degree with nutritional supplementation (Martorell et al, 1994). This suggests that catch-up growth is impaired by conditions found in the environment in which the children became stunted. It is well esta...

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Metabolic Cost of Growth in Very Low-Birth-Weight Infants

Cited by 64 publications

References 13 publications

Estimation of 24-Hour Energy Expenditure from Shorter Measurement Periods in Premature Infants

Estimation of 24-Hour Energy Expenditure from Shorter Measurement Periods in Premature Infants

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

High fat versus high carbohydrate nutritional supplementation: a one year trial in stunted rural Gambian children

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