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Role of Protein and Amino Acids in Infant and Young Child Nutrition: Protein and Amino Acid Needs and Relationship with Child Growth

November 2015
Journal of Nutritional Science and Vitaminology 61(Supplement):S192-S194

DOI:10.3177/jnsv.61.S192

Project: Epigenetics of Obesity : Effective Prevention of childhood obesity

Authors:

Ricardo Uauy

London School of Hygiene and Tropical Medicine

Anura Kurpad

St. John's National Academy of Health Sciences

Kwaku Tano-Debrah

University of Ghana

Gloria E. Otoo

University of Ghana

Show all 7 authorsHide

Over a third of all deaths of children under the age of five are linked to undernutrition. At a 90% coverage level, a core group of ten interventions inclusive of infant and young child nutrition could save one million lives of children under 5 y of age (15% of all deaths) (Lancet 2013). The infant and young child nutrition package alone could save over 220,000 lives in children under 5 y of age. High quality proteins (e.g. milk) in complementary, supplementary and rehabilitation food products have been found to be effective for good growth. Individual amino acids such as lysine and arginine have been found to be factors linked to growth hormone release in young children via the somatotropic axis and high intakes are inversely associated with fat mass index in pre-pubertal lean girls. Protein intake in early life is positively associated with height and weight at 10 y of age. This paper will focus on examining the role of protein and amino acids in infant and young child nutrition by examining protein and amino acid needs in early life and the subsequent relationship with stunting.

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J Nutr Sci Vitaminol, 61, S192–S194, 2015

Protein and Amino Acid Needs

FAO/WHO requirements for protein and amino acids

(across all age groups) have varied considerably over

the years (1–3). Considerable research on require-

ments shows that intakes at which balance is achieved

are variable in and across individuals being affected by

variability in metabolic demand, genotype, and factors

that affect phenotype as well as states of active growth,

pregnancy and lactation. Efﬁciency of utilization (or

net protein utilization), dietary intakes of other nutri-

ents, lifestyle and environmental inﬂuences (including

infection) could also alter the minimum protein require-

ment (4). The composition and pattern of amino acids

in a diet is also important to generate a suitable mix

that will match metabolic demand for protein synthe-

sis and other needs. Compared to previous estimates,

current protein requirements are lower in both adults

and children; however, amino acid requirements remain

the same in children and are signiﬁcantly higher in

adults (4). Effectively higher quality protein (to achieve

the amino acid pattern) is required in smaller quanti-

ties. The essential amino acid requirements for adults

are twice the previous recommendations with lysine

requirements having increased 2.5 times from 12 mg/

kg body weight to 30 mg/kg body weight in adults (4).

In children, the essential amino acid requirements are

only slightly lower (94% of previous estimate for lysine).

Protein and amino acid requirements as deﬁned by the

current FAO/WHO 2007 report for all age groups are

provided in Table 1. Interactions between energy deﬁ-

cit and protein needs also affect nitrogen equilibrium.

These have been examined and reviewed extensively (5).

Energy imbalance (both excess and deﬁcit) affects body

nitrogen balance. At a protein intake of 0.57 g/kg body

weight, N equilibrium is achieved if energy intake is

~10–15% above that required (2, 3). Conversely people

in energy deﬁcit need additional protein and a modest

energy deﬁcit increases protein needs by about 10%

(6). Such ﬂuctuations in needs are not accounted for in

the estimation of requirements. Several other possible

functions have an impact on protein and amino acid

needs. In environments where individuals have persis-

tent immune activation and where possibly a decline in

intestinal absorptive capacity is present, while there are

no overt clinical symptoms, there is still an increased

demand for protein (4, 7). Thus in vulnerable popula-

tions such as women and children commonly affected

by acute and chronic infections, protein and amino acid

Role of Protein and Amino Acids in Infant and

Young Child Nutrition: Protein and Amino Acid Needs and

Relationship with Child Growth

Ricardo UaUy1,*, Anura KUrpad2, Kwaku Tano-debrah3, Gloria E. oToo3, Grant A. aaron4,

Yasuhiko Toride5 and Shibani Ghosh1,6

1 Nevin Scrimshaw International Nutrition Foundation, 711 Washington Street, Boston, USA

2 St Johns Medical College, Bengaluru, India

3 Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana

4 Global Alliance for Improved Nutrition, Geneva, Switzerland

5 Ajinomoto Co., Inc., Tokyo, Japan

6 Friedman School of Nutrition Science and Policy, Tufts University,

150 Harrison Avenue, Boston, MA 02111, USA

Summary Over a third of all deaths of children under the age of ﬁve are linked to under-

nutrition. At a 90% coverage level, a core group of ten interventions inclusive of infant

and young child nutrition could save one million lives of children under 5 y of age (15%

of all deaths) (Lancet 2013). The infant and young child nutrition package alone could save

over 220,000 lives in children under 5 y of age. High quality proteins (e.g. milk) in comple-

mentary, supplementary and rehabilitation food products have been found to be effective for

good growth. Individual amino acids such as lysine and arginine have been found to be fac-

tors linked to growth hormone release in young children via the somatotropic axis and high

intakes are inversely associated with fat mass index in pre-pubertal lean girls. Protein intake

in early life is positively associated with height and weight at 10 y of age. This paper will

focus on examining the role of protein and amino acids in infant and young child nutrition

by examining protein and amino acid needs in early life and the subsequent relationship

with stunting.

Key Words protein, amino acids, protein quality, complementary foods, infant and young

child nutrition

* Present address: INTA Universidad de Chile, El Líbano

5524, Macul, Santiago de Chile, Chile

E-mail: druauy@gmail.com

Protein and Amino Acids in Infant and Young Child Nutrition S193

needs are likely to be greater. Growth rates (especially

linear) are likely to be affected by repeated infections

(bacterial and parasitic) with long-term implications

including decreased productivity and functional deﬁ-

cits (7, 8). Requirements of amino acids such as lysine

are signiﬁcantly higher in chronically undernourished

adults suffering from intestinal infections (9, 10).

Protein and Amino Acids in Child Health and

Nutrition

Studies have shown a positive impact of incorpo-

rating high quality protein rich foods into the diets of

young school children (11). An analysis of dietary and

anthropometric data collected on Ghanaian children

aged 2–13 y, found an association between protein

quality and risk of being stunted (12) irrespective of

energy. Total energy, total protein and total utilizable

protein availability estimates have been independently

signiﬁcantly and negatively associated with prevalence

of stunting in analyses of 200 countries (p,0.001).

Total energy explains 41% of the variation in stunting,

total protein explains 34% of the variation and utiliz-

able protein (function of protein quality) 40% in preva-

lence of stunting. Controlling for total energy, utilizable

(not total) protein is signiﬁcantly associated with stunt-

ing (43% of the variation in stunting p50.006 total

energy and p50.017 utilizable protein) (13). High pro-

tein intakes are reported in European children during

the complementary feeding period (14) and are indica-

tive of having a growth-stimulating role (especially that

of linear growth) through effects on insulin-like growth

factor (IGF-1). High quality proteins (e.g. milk) to com-

plementary, supplementary and rehabilitation food

products has also been found to be effective for growth.

Individual amino acids such as lysine and arginine have

been found to be factors linked to growth hormone

release in young children via the somatotropic axis and

high intakes are inversely associated with fat mass index

in prepubertal lean girls. Protein intake in early life is

positively associated with height and weight at 10 y of

age. Furthermore, there is an effect of dietary restric-

tion of single essential amino acids including leucine,

lysine, methionine and threonine on plasma IGF-I pro-

duction. A decrease in retro-peritoneal fat mass and an

increase in lean body mass have been documented in rat

models supplemented with l-arginine and conjugated

linoleic acid. Further work needs to be done to examine

these relationships more closely and to understand the

role of protein and amino acids within the context of

quality rather than quantity in infant and young child

nutrition.

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Protein requirements

(g/kg per day) for His Ile Leu Lys SAA AAA Thr Trp Val

Age (years) Maintenance Growth Amino acid requirements (mg/kg per day)

0.5 0.66 0.46 22 36 73 64 31 59 34 9.5 49

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Article

Mar 2002

Background: In earlier studies with well-nourished subjects that used a 24-h indicator amino acid oxidation or balance approach, we concluded that the 1985 FAO/WHO/UNU requirement for lysine (12 mg . kg(-1) . d(-1)) was inadequate for healthy South Asian subjects and proposed a tentative requirement of 30 mg . kg(-1) . d(-1). Objective: We assessed whether chronic undernutrition, with low habitual dietary protein and lysine intakes, leads to changed lysine requirements. Design: Twenty-seven otherwise clinically healthy, chronically undernourished Indian men were studied during 2 randomly assigned 7-d diet periods supplying 12 and 30, 18 and 36, or 24 and 42 mg lysine . kg(-1) . d(-1), based on an L-amino acid diet. The subjects' leucine intake was 40 mg . kg(-1) . d(-1). At 1800 on day 6, a 24-h intravenous [C-13]leucine tracer-infusion protocol was conducted to assess leucine oxidation and daily leucine balance at each test lysine intake. Results: A breakpoint was not identified in the lysine intake-leucine oxidation or balance-response over the range of intakes studied. Mixed-models linear regression analysis indicated a mean requirement of 44 mg lysine . kg(-1) . d(-1) (95% CI: 36, 63) for the lysine intake-leucine balance relation. Conclusions: The mean lysine requirement in chronically undernourished men is estimated to be higher than the value of 30 mg . kg(-1) . d(-1) proposed for well-nourished individuals. This may be related to body-composition differences. It also suggests that these subjects have not elicited a metabolic adaptation in response to their habitually low lysine intakes by substantially improving their efficiency of dietary lysine utilization.

World Essential Amino Acid Supply with Special Attention to South-East Asia

Article

Sep 1996

Peter L. Pellett

On the basis of calculations using regional and country food balance sheets, dietary surveys from Pakistan and India, and amino acid composition data, it is proposed that the essential amino acid lysine may be relatively lacking in many areas of the world where diets heavily based on cereals are consumed. By combining food balance sheet and gross national product data, it can be demonstrated that as wealth increases, not only are more food energy and protein available, but there are also major changes in the pattern of foods selected. When dietary and health data are stratified by gross national product, the poorest countries, with a combined population of nearly 3,000 million, have the highest proportion of their protein originating from plant sources. These are also the countries with the lowest life expectancy and the highest mortality rate among children under five years of age. Rich countries, in contrast, obtain much of their protein from animal sources. Such different dietary patterns of the rich and the poor lead to very different daily availabilities of lysine. Although large differences also exist for all other essential amino acids, the difference is considered to be nutritionally significant only for lysine. The coefficient of variation (CV %) in lysine content in some 100 dietary calculations was more than three times the average CV % of the other essential amino acids. The amino acid compositions of animal, pulse, and cereal proteins are also sufficiently different from each other to allow food group data to be used to predict the lysine value of diets. Dietary survey data from both India and Pakistan showed wide intra-country variations of lysine availability. Average lysine values were low in both countries and would indicate a considerable risk of inadequate levels of intake in many subsections of the population. Strategies to alleviate possible global problems of low lysine supply must include improving dietary diversity as well as consideration of cereal nutrient fortification.

Effect of early protein intake on linear growth velocity and development of adiposity

Article

Dec 2003

Protein deficiency results in retarded growth, and many studies from developing countries have shown that animal protein has a growth-promoting effect in children getting a diet mainly based on vegetable products. To what degree this is caused by an improved protein quality, nutrients associated with animal protein such as zinc, or a growth-stimulating effect of certain amino acids or peptides is not known. In industrialized countries, it is not likely that either the amount of protein or the protein quality will be growth limiting in healthy children. However, there are data suggesting that the high protein intake in infants and young children seen in industrialized countries could have growth-modulating effects and that there could be long-term effects. The aim of this paper is to review data on the association between early protein intake and linear growth velocity and early protein intake and later development of obesity. The review will focus on term healthy infants and young children from industrialized countries. The review will also include data on differences in growth and development of obesity between breastfed and formula-fed infants as there are considerable differences in protein intake between these two groups and one of the suggested causes for these effects has been difference in protein intake.

Food Supplements Have a Positive Impact on Weight Gain and the Addition of Animal Source Foods Increases Lean Body Mass of Kenyan Schoolchildren

Article

Nov 2003

Observational studies of dietary patterns and growth and studies with milk supplementation have shown that children consuming diets containing animal source foods grow better. This study evaluates the growth of 544 Kenyan schoolchildren (median age 7.1 y) after 23 mo of food supplementation with a meat, milk or energy supplement (similar to1255 W) compared to a control group without a supplement. Multivariate analyses controlled for covariates compared gain in weight, height, weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), mid-upper-arm circumference, triceps and subscapular skinfolds, mid-upper-arm muscle and mid-upper-arm fat area. Children in each of the supplementation groups gained similar to0.4 kg (10%) more weight than children in the Control group. Children in the Meat, Milk and Energy groups gained 0.33, 0.19 and 0.27 cm more, respectively, in mid-upper-arm circumference than children in the Control group. Children who received the Meat supplement gained 30-80% more mid-upper-arm muscle area than children in the other groups, and children who received the milk supplement gained 40% more mid-upper-arm muscle area than children who did not receive a supplement. No statistically significant overall effects of supplementation were found on height, HAZ, WHZ or measures of body fat. A positive effect of the milk supplement on height gain could be seen in the subgroup of children with a lower baseline HAZ (less than or equal to -1.4). The results indicate that food supplements had a positive impact on weight gain in the study children and that the addition of meat increased their lean body mass.

Human Protein Requirements: Interrelationships between Energy Intake and Nitrogen Balance in Young Men Consuming the 1973 FAO/WHO Safe Level of Egg Protein, with Added Non-Essential Amino Acids

Article

Feb 1978

Our recent studies have shown that the 1973 FAO/WHO "safe level of intake" of egg protein (0.57 g/kg/day) is inadequate for maintaining protein nutritional status in young men receiving generous energy intakes. Therefore, an experiment was conducted to determine nitrogen (N) balance and the energy intake needed to support it when supplementary N, equivalent to 0.23 g of protein (N X 6.25)/kg/day from a nonessential amino acid mixture, was added to a diet containing 0.57 g of egg protein/kg/day. Four young men, 20 to 21 years old, participated in the 58- to 79-day metabolic N balance study. This group required significantly lower energy intakes to maintain N balance than a previously studied group fed only 0.57 g of egg protein under identical conditions. The energy intakes predicted to maintain N balance were approximately 10 to 15% less than the requirements estimate from body weight and N balance data. Present results, although based on a limited number of subjects, suggest that total N may be the limiting factor in short-term N balance at the 1973 FAO/WHO egg protein intake level for a significant proportion of young adult male populations. Long-term metabolic studies will be necessary before the practical significance of the observations can be determined.

Requirement and Utilization of Egg Protein by Japanese Young Men with Marginal Intakes of Energy

Article

May 1978

The effect of marginal intakes of energy on the requirement and utilization of egg protein was evaluated in 46 Japanese young men. The subjects were given a standard diet for 1 week and then low protein diets for 2 weeks. These diets contained about 32, 64, and 80 mgN/kg with whole eggs as the protein source. In the first experiment with excess energy, the energy intakes of 31 subjects were kept constant during the 3 week experiment, the mean intakes being 48.2 +/- 1.5 kcal/kg. The body weight was affected by changing protein intakes while maintaining energy intakes at 48 kcal/kg. From regression analysis, the N requirement for apparent N equilibrium was estimated to be 82.0 +/- 8.0 mgN/kg, where NPU was calculated as 56. In the second experiment with submaintenance energy, 15 subjects received 40 kcal/kg. The N requirement was 124 +/- 21 mgN/kg, where NPU was calculated as 37. From these results and those of previous studies, it was concluded as follows: 1) N balance and NPU were remarkably affected by energy intake changed around maintenance level; and 2) the NPU for egg protein in young men for maintenance intakes of energy and N is about 50 to 55. For estimation of the protein requirement for Japanese adults, a correction factor of 100/55 (about 1.8) was used instead of 1.3 adopted by the 1973 FAO/WHO.

Human protein requirements: The effect of variations in energy intake within the maintenance range

Article

Apr 1976

Protein requirement studies in man generally avoid deficient dietary energy intakes because they decrease the efficiency of nitrogen utilization, but the opposite effect of excess dietary energy is usually overlooked. Four young men were fed the 1973 FAO/WHO safe level of egg protein (0.57 g/kg) at several levels of dietary energy. The data indicate that a significant proportion of the population may require excess energy intakes to maintain nitrogen balance at this level of dietary protein. Variations in dietary energy ranging from submaintenance to 15 to 20% above estimated maintenance needs altered net egg protein utilization in three subjects by 2 to 4.5 units/kcal per kg body wt.

Interactions of Nutrition and Infection

Article