Validation of energy requirement references for exclusively breast-fed infants

Nielsen, S.B., Wells, J.C.K., Fewtrell, M.S., Eaton, S., Grinham, J. and Reilly, J.J. (2013) Validation of energy requirement references for exclusively breast-fed infants. British Journal of Nutrition, 109(11), pp. 2036-2043. (doi: 10.1017/S000711451200428X)

Abstract

In paediatric practice, mean reference energy requirements for groups are often used to predict individual infant energy requirements. References from the FAO/WHO/United Nations University are based on infants not fed according to the current infant feeding recommendations. The objective of the present study was to measure total energy expenditure (TEE) and determine energy requirements using criterion methods, and validate the use of TEE prediction equation and mean energy requirement references for predicting individual TEE and energy requirements, respectively, in infants who were exclusively breast-fed (EBF) to 6 months of age. EBF infants were included from Greater Glasgow for measurements at 3·5 (n 36) and 6 (n 33) months of age. TEE was measured using doubly labelled water and energy requirements were determined using the factorial approach. TEE and energy requirements were also predicted using equations based on body weight. Relationships between criterion methods and predictions were assessed using correlations. Paired t tests and Bland–Altman plots were used to assess agreement. At the population level, predicted and measured TEE were similar. The energy requirement reference significantly underestimated energy requirements by 7·2 % at 3·5 months at the population level, but there was no bias at 6 months. Errors at individual levels were large and energy requirements were underestimated to a larger extent for infants with higher energy requirements. This indicates that references presently used in clinical practice to estimate energy requirements may not fully account for the different growth pattern of EBF infants. More studies in infants EBF to 6 months of age are needed to understand how growth of EBF infants influences energy requirements.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Nielsen, Ms Susan and Reilly, Prof John and Fewtrell, Dr Mary
• Authors: Nielsen, S.B., Wells, J.C.K., Fewtrell, M.S., Eaton, S., Grinham, J., and Reilly, J.J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: British Journal of Nutrition
• Journal Abbr.: Brit. J. Nutr.
• Publisher: Cambridge University Press
• ISSN: 0007-1145
• ISSN (Online): 1475-2662
• Copyright Holders: Copyright © 2012 The Authors
• First Published: First published in British Journal of Nutrition 109(11):2036-2043
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher