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

European Journal of Clinical Nutrition volume 64, pages S5–S7 (2010)Cite this article

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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.

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  1. Departments of Paediatrics and Nutritional Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada

    P B Pencharz

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  1. P B Pencharz
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Correspondence to P B Pencharz.

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PB Pencharz has received grant support from CIHR.

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Pencharz, P. Protein and energy requirements for ‘optimal’ catch-up growth. Eur J Clin Nutr 64 (Suppl 1), S5–S7 (2010). https://doi.org/10.1038/ejcn.2010.39

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