ArticlePDF Available

Abstract

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.
192
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 (13). 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.
REFERENCES
1) Pellett PL. 1996. World essential amino acid supply
with special attention to South-East Asia. Food Nutr Bull
17(3): 204–234.
2) Garza C, Scrimshaw NS, Young VR. 1978. Human pro-
tein requirements: interrelationships between energy
intake and nitrogen balance in young men consum-
ing the 1973 FAO/WHO safe level of egg protein, with
added non-essential amino acids. J Nutr 108(1): 90–96.
3) Garza C, Scrimshaw N, Young V. 1976. Human protein
requirements: the effect of variations in energy intake
within the maintenance range. Am J Clin Nutr 29(3):
280–287.
4) WHO. 2007. Protein and amino acid requirements in
human nutrition. Report of a Joint WHO/FAO/UNU
Expert Consultation. WHO Technical Report Series.
World Health Organization (WHO Technical Report
Series, No. 935), Geneva.
5) Pellett PL, Young VR. 1991. The effects of different lev-
els of energy intake on protein metabolism and of dif-
ferent levels of protein intake on energy metabolism: A
statistical evaluation from the published literature. In:
Table 1. Protein and amino acid requirements.
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
1–2 0.66 0.2 15 27 54 45 22 40 23 6.4 36
3–10 0.66 0.07 12 23 44 35 18 30 18 4.8 29
11–14 0.66 0.07 12 22 44 35 17 30 18 4.8 29
15–18 0.66 0.04 11 21 42 33 16 28 17 4.5 28
.18 0.66 0 10 20 39 30 15 25 15 4 26
Scoring pattern (mg/g protein requirement)
0.5 20 32 66 57 28 52 31 8.5 43
1–2 18 31 63 52 26 46 27 7.4 42
3–10 16 31 61 48 24 41 25 6.6 40
11–14 16 30 60 48 23 41 25 6.5 40
15–18 16 30 60 47 23 40 24 6.3 40
.18 15 30 59 45 22 38 23 6 39
Source: WHO 2007.
Uauy R et al.
S194
(Scrimshaw NS, Schurch B, eds). International Dietary
Energy Consultancy Group, Waterville Valley, NH, USA.
6) Kishi K, Miyatani S, Inoue G. 1978. Requirement and
utilization of egg protein by Japanese young men with
marginal intakes of energy. J Nutr 108(4): 658–669.
7) Dewey KG, Beaton G, Fjeld C, Lonnerdal B, Reeds P,
Brown KH, Heinig MJ, Ziegler E, Raiha NCR, Axelsson
IEM. 1996. Protein requirements of infants and chil-
dren. Eur J Clin Nutr 50: S119–S150.
8) Scrimshaw NS, Taylor CE, Gordon JE. 1959. Interactions
of nutrition and infection. Am J Med Sci 237: 367–403.
9) Kurpad AV, Regan MM, Raj T, Vasudevan J, Kuriyan R,
Gnanou J, Young VR. 2003. Lysine requirements of
chronically undernourished adult Indian men, mea-
sured by a 24-h indicator amino acid oxidation and bal-
ance technique. Am J Clin Nutr 77(1): 101–108.
10) Kurpad AV, Raj T, El-Khoury A, Beaumier L, Kuriyan R,
Srivatsa A, Borgonha S, Selvaraj A, Regan MM, Young
VR. 2001. Lysine requirements of healthy adult Indian
subjects, measured by an indicator amino acid balance
technique. Am J Clin Nutr 73(5): 900–907.
11) Grillenberger M, Neumann CG, Murphy SP, Bwibo
NO, van’t Veer P, Hautvast JGAJ, West CE. 2003. Food
supplements have a positive impact on weight gain
and the addition of animal source foods increases lean
body mass of Kenyan schoolchildren. J Nutr 133(11):
3957S–3964S.
12) Ghosh S, Suri D, Vuvor F, Armah SM, Scrimshaw NS,
Uauy R. 2010. Dietary protein quality is associated with
risk of being stunted in peri-urban children in Greater
Accra. 2nd World Public Health Congress on Nutrition,
Porto, Portugal.
13) Ghosh SA, Suri D, Uauy R. 2012. Assessment of protein
adequacy in developing countries: Quality matters. Br J
Nutr 108: S77–S87.
14) Michaelsen K, Hoppe C, Mølgaard C. 2003. Effect of
early protein intake on linear growth velocity and
development of adiposity. Monatsschrift Kinderheilkunde
151(0): S78–S83. doi: 10.1007/s00112-003-0805-z
... These estimates do not consider the added requirements of catch-up growth (Pillai & Kurpad, 2012), or the high infectious disease burden common among children in developing countries (Uauy, 2013). Even a modest energy deficit, as often found in LMICs, may increase protein needs (Pillai et al., 2015;Uauy, 2013;Uauy et al., 2015). There is therefore a need to re-evaluate the EAA requirements for infants and young children in developing countries. ...
... As growth and neurocognitive development are dependent on the same regulatory pathway, controlled by common stimuli (i.e., AAs) (Jewell et al., 2013;Semba, Trehan, Gonzalez-Freire, et al., 2016), effects on linear growth can occur in tandem with cognitive effects (Uauy et al., 2015). If there are nutritional deficiencies during this vulnerable phase, linear growth will falter (Uauy et al., 2015) and cognitive development as well as cognitive functioning can be affected (Uauy et al., 2015;Wu, 2010). ...
... As growth and neurocognitive development are dependent on the same regulatory pathway, controlled by common stimuli (i.e., AAs) (Jewell et al., 2013;Semba, Trehan, Gonzalez-Freire, et al., 2016), effects on linear growth can occur in tandem with cognitive effects (Uauy et al., 2015). If there are nutritional deficiencies during this vulnerable phase, linear growth will falter (Uauy et al., 2015) and cognitive development as well as cognitive functioning can be affected (Uauy et al., 2015;Wu, 2010). ...
Article
Full-text available
Growth faltering under 5 years of age is unacceptably high worldwide, and even more children, while not stunted, fail to reach their growth potential. The time between conception and 2 years of age is critical for development. The period from 6 to 23 months, when complementary foods are introduced, coincides with a time when growth faltering and delayed neurocognitive developments are most common. Fortunately, this is also the period when diet exercises its greatest influence. Growing up in an adverse environment, with a deficient diet, as typically seen in low- and middle-income countries (LMICs), hampers growth and development of children and prevents them from realising their full developmental and economic future potential. Sufficient nutrient availability and utilisation are paramount to a child's growth and development trajectory, especially in the period after breastfeeding. This review highlights the importance of essential amino acids (EAAs) in early life for linear growth and, likely, neurocognitive development. The paper further discusses signalling through mammalian target of rapamycin complex 1 (mTORC1) as one of the main amino acid (AA)-sensing hubs and the master regulator of both growth and neurocognitive development. Children in LMICs, despite consuming sufficient total protein, do not meet their EAA requirements due to poor diet diversity and low-quality dietary protein. AA deficiencies in early life can cause reductions in linear growth and cognition. Ensuring AA adequacy in diets, particularly through inclusion of nutrient-dense animal source foods from 6 to 23 months, is strongly encouraged in LMICs in order to compensate for less than optimal growth during complementary feeding.
... Linkages between food groups having high-quality protein and growth are found in previous studies, although these studies had focused on different age groups (39,40). The findings are similar to the results found that utilizable protein is negatively associated with stunting (41,42). This indicates that high-quality proteins should be given importance since they are beneficial for child growth, specifically foods rich in amino acids lysine and arginine are both linked to growth hormone release (41). ...
... The findings are similar to the results found that utilizable protein is negatively associated with stunting (41,42). This indicates that high-quality proteins should be given importance since they are beneficial for child growth, specifically foods rich in amino acids lysine and arginine are both linked to growth hormone release (41). Dietary risk factors of physical growth ...
Article
Full-text available
Background: Adequate nutrition during childhood is essential to promote child growth and development. Objective: The study evaluated the relationship of habitual nutrient intake and protein adequacy to the prevalence of child malnutrition. Methods: Data were derived from a nationally representative sample of children aged 6–12 years. Two nonconsecutive day 24-h dietary recalls (24hR) were collected to estimate the individual food intake. PC-SIDE version 1.0 software (Software for Intake Distribution Estimation) was used to estimate the habitual intake of key nutrients accounting for between- and within-person differences in dietary intake. The 2007 WHO Protein Digestibility Corrected Amino Acid Score (PDCAAS) method was used to measure the protein quality or the utilizable protein intake. The nutritional status of the participants is reflected in the weight-for-age, height-for-age, and body mass index (BMI)-for-age z-scores using the WHO Growth Reference Standard (WHO, 2007). Results: Undernourished school-aged children were found to have high protein inadequacy. Higher consumption of grains and cereal products, meat, and high-quality protein foods was associated with a lower risk of stunting. Higher intake of milk and milk products, grains and cereal products, high-quality protein foods, calcium, riboflavin, and vitamin C was associated with a lower risk of underweight. Higher consumption of grains and cereal products, riboflavin, thiamine, and fiber was associated with a lower risk of wasting. On the contrary, higher consumption of meat, milk and milk products, grains and cereal products, high-quality protein foods, and vitamin C was associated with a higher risk of obesity. Furthermore, linear growth of children was found to be associated with high-quality protein foods, calcium, vitamin B12, vitamin C, and vitamin D. Conclusions: Malnutrition among Filipino children is influenced by nutrient intakes. However, the existence of malnutrition among children may be specifically attributed to the quality of protein consumed. Therefore, the study suggests that nutrition interventions and policies focusing on child malnutrition should improve not just the quantity but also the quality of protein sources consumed by children to aid in proper growth and development.
... Malnutrition caused by the insufficient intake of amino acids, especially the essential amino acids that humans and livestock are unable to carry out by de novo biosynthesis, is a serious problem around the world. Worldwide, it is estimated that more than a third of all deaths among children under the age of five are linked to protein or amino acid malnutrition [6]. In 2017, there were 515 million people with chronic malnutrition due to the insufficient intake of amino acids around the world, and these people are mainly concentrated in developing countries and regions with rice (Oryza sativa L.) as their staple food [7,8]. ...
Article
Full-text available
Rice is one of the most important food crops in the world, and amino acids in rice grains are major nutrition sources for the people in countries where rice is the staple food. Phytohormones and plant growth regulators play vital roles in regulating the biosynthesis of amino acids in plants. This paper reviewed the content and compositions of amino acids and their distribution in different parts of ripe rice grains, and the biosynthesis and metabolism of amino acids and their regulation by polyamines (PAs) and phytohormones in filling grains, with a focus on the roles of higher PAs (spermidine and spermine), ethylene, and brassinosteroids (BRs) in this regulation. Recent studies have shown that higher PAs and BRs (24-epibrassinolide and 28-homobrassinolide) play positive roles in mediating the biosynthesis of amino acids in rice grains, mainly by enhancing the activities of the enzymes involved in amino acid biosynthesis and sucrose-to-starch conversion and maintaining redox homeostasis. In contrast, ethylene may impede amino acid biosynthesis by inhibiting the activities of the enzymes involved in amino acid biosynthesis and elevating reactive oxygen species. Further research is needed to unravel the temporal and spatial distribution characteristics of the content and compositions of amino acids in the filling grain and their relationship with the content and compositions of amino acids in different parts of a ripe grain, to elucidate the cross-talk between or among phytohormones in mediating the anabolism of amino acids, and to establish the regulation techniques for promoting the biosynthesis of amino acids in rice grains.
... food-related biological systems (Carpenter, 2003;Cheung et al., 2016;Cifuentes, 2012;Mozaffarian, Rosenberg, & Uauy, 2018;Semba, 2012;Ulaszewska et al., 2019). indicative in addition to the many other reasons why the reductionist paradigm may continue to dominate the methodological approaches to food and nutrition research (Hussain, Abbas, Khan, & Scrimshaw, 2004;Mozaffarian et al., 2018;Uauy et al., 2015). Generally, the traditional quantitative or positivist orientation of the principles guiding the conduct of epidemiological studies of infectious diseases lends itself to nutritional epidemiological studies too, where causal inferences and interpretations are the ultimate goals of most NER studies (Broadbent, 2013;Hansson, 2014). ...
... In this treatment, the protein content decreased, especially the use of the T4 method (Table 1). Protein contains the element N in it (Uauy et al., 2015). Therefore, the low protein content indicates the low N content in the sample. ...
Article
The preparation process needs to be carried out in the treatment of hatchery waste. The objective of the study was to determine the mineral content and characterization of the eggshell waste after preparation. An experiment was arranged on a completely randomized design (CRD). Preparation treatment consisted of; T1: shell waste watered with distilled water; T2: shell waste soaked in distilled water for 12 h; T3: shell waste soaked in 0.5% NaOH for 720 min; and T4: shell waste boiled at 80°C for 15 min and soaked in 5% H3PO4 for 15 min. The data were analyzed using Analysis of Variance (ANOVA), and if any differences, a Duncan Multiple Range Test (DMRT) post hoc tests were carried out. Composition of proximate and mineral were detected by using X-Ray Fluorescence (XRF). Results indicated that proximate analysis of the dry matter content were T4: 98.98±0.01; T3: 98.58±0.04; T2: 98.75±0.08; and T1: 98.72±0.03. The calcium content of the treatment from the highest was T3: 24.22±0.31; T1: 22.80±0.57; T2: 22.77±0.71; and T4: 21.55±0.46. It may be inferred that the treatment technique had no major impact on the eggshells physical characteristics. However, boiling treatment at 80°C for 15 min and soaking in 5% H3PO4 reduced the eggshell waste's Mg, Si, and Ca content. The addition of 0.5% NaOH immersion did not degrade Mg, Ca, and Si of eggshell waste.
... Infant nutrition during the first two years of life is essential for adequate development and crucial for survival and long-term health and well-being. Nourishment deficiencies caused by inadequate nutrition during this development stage may cause immediate damage, increasing infant morbidity and mortality, while also potentiating growth delays and low school achievements and increasing the risks for chronic and degenerative adulthood diseases [1,2]. In this regard, breast milk is the complete and ideal infant nutritional source, endorsed by health authorities and recommended as the exclusive food source during the first six months of life, aiming at optimal child growth, development, and health. ...
Article
Full-text available
Infant formulas, designed to provide similar nutritional composition and performance to human milk, are recommended when breastfeeding is not enough to provide for the nutritional needs of children under 12 months of age. In this context, the present study aimed to assess the protein quality and essential amino acid content of both starting (phase 1) and follow-up (phase 2) formulas from different manufacturers. The chemical amino acid score and protein digestibility corrected by the amino acid score were calculated. The determined protein contents in most formulas were above the maximum limit recommended by FAO and WHO guidelines and at odds with the protein contents declared in the label. All infant formulas contained lactoferrin (0.06 to 0.44 g·100 g−1) and α-lactalbumin (0.02 to 1.34 g·100 g−1) below recommended concentrations, whereas ĸ-casein (8.28 to 12.91 g·100 g−1), α-casein (0.70 to 2.28 g·100 g−1) and β-lactoglobulin (1.32 to 4.19 g·100 g−1) were detected above recommended concentrations. Essential amino acid quantification indicated that threonine, leucine and phenylalanine were the most abundant amino acids found in the investigated infant formulas. In conclusion, infant formulas are still unconforming to nutritional breast milk quality and must be improved in order to follow current global health authority guidelines.
... This could be explained by the similar amount of protein and zinc found in the LIBS and CSB+. Complementary, supplementary, and therapeutic foods with good quality protein are effective for promoting the growth of children [34]. Similarly, zinc is vital for growth and development and is a growth ...
Article
Full-text available
Background Globally, moderate acute malnutrition (MAM) affects approximately 5% of children below five years of age. MAM is a persistent public health problem in Ethiopia. The current approach in Ethiopia for managing MAM is a supplementary feeding program; however, this is only provided to chronically food-insecure areas. The objective of the study was to compare a local-ingredients-based supplement (LIBS) with the standard corn-soy blend plus (CSB+) in treating MAM among children aged 6 to 59 months to test the hypothesis that the recovery rate achieved with LIBS will not be more than 7% worse than that achieved with CSB+. Methods and findings We used an individual randomized controlled non-inferiority trial design with two arms, involving 324 children with MAM aged 6 to 59 months in Wolaita, Southern Ethiopia. One hundred and sixty-two children were randomly assigned to each of the two arms. In the first arm, 125.2 g of LIBS with 8 ml of refined deodorized and cholesterol-free sunflower oil/day was provided. In the second arm, 150 g of CSB+ with 16 ml of refined deodorized and cholesterol-free sunflower oil/day was provided. Each child was provided with a daily ration of either LIBS or CSB+ for 12 weeks. Both intention-to-treat (ITT) and per-protocol (PP) analyses were done. ITT and PP analyses showed non-inferiority of LIBS compared with CSB+ for recovery rate [ITT risk difference = 4.9% (95% CI: -4.70, 14.50); PP risk difference = 3.7% (95% CI: –5.91, 13.31)]; average weight gain [ITT risk difference = 0.10 g (95% CI: -0.33 g, 0.53 g); PP risk difference = 0.04 g (95% CI: -0.38 g, 0.47 g)]; and recovery time [ITT risk difference = -2.64 days (95% CI: -8.40 days, 3.13 days); PP difference -2.17 days (95% CI: -7.97 days, 3.64 days]. Non-inferiority in MUAC gain and length/height gain was also observed in the LIBS group compared with the CSB+ group. Conclusions LIBS can be used as an alternative to the standard CSB+ for the treatment of MAM. Thus, the potential of scaling up the use of LIBS should be promoted. Trial registration Pan-African Clinical Trial Registration number: PACTR201809662822990 .
Article
Background Varying protein intake is known to influence human height growth. However, whether a habitually higher protein intake consistently above dietary recommendations during childhood and adolescence impacts on adult stature is not known. Methods We, therefore, examined habitual protein intake based on 3-day weighed dietary records and 24-h urinary biomarker excretions in a longitudinal cohort of 189 healthy individuals between age 3 and 17 years (analyzing 11 diet recordings and 11 24-urine samples per child on average). Urinary urea nitrogen (uN) excretion was used as biomarker for protein intake. Multilinear regressions were applied to examine the prospective associations of average total and average animal protein intake during growth with the outcome adult height (AH) after adjusting for parental heights, energy intake, dietary potential renal acid load (PRAL), and pubertal, early life, and socioeconomic factors. Results Mean standard deviation scores of total (P = .001) and animal (P < .0001) protein intake as well as uN (P = .01) were prospectively and independently related to adult height in girls, but not in boys. Also for girls only, the fully adjusted regression for renal biomarkers (R 2total = 0.79) indicated an inverse relationship between AH and the urinary biomarker for dietary acidity PRAL (P = .06). Conclusion Our prospective, biomarker-confirmed findings on habitual protein intake during the pediatric period provide evidence that protein ingestion above dietary recommendation contributes to an enhanced AH in girls. This enhancement, in turn, may be weakened by an insufficient alkalizing potential through a PRAL-raising fruit- and vegetable-poor nutrition.
Article
Full-text available
Background: High prevalence of maternal malnutrition, low birth-weight and child malnutrition in India contribute substantially to the global malnutrition burden. Rural India has disproportionately higher levels of child malnutrition. Stunting and wasting are the primary determinants of child malnutrition and their district-level distribution shows clustering in different geographies and regions. Cereals, particularly millets, constitute the bulk of protein intake among the poor, especially in rural areas in India where high prevalence of wasting persists. Methods: The last round of National Family Health Survey (NFHS4) has disaggregated data by district, enabling a more fine-scale characterisation of the prevalence of markers of malnutrition. We used data from NFHS4 and agricultural statistics datasets to analyse relationship of prevalence of malnutrition at the district level and area under cereal cultivation. We analysed malnutrition through data on under-5 stunting and wasting by district. Results: Stunting and wasting patterns across districts show a distinct geographical and age distribution; districts with higher wasting showed relatively higher prevalence before six months of age. Wasting prevalence at district level was associated with higher cultivation of millets, with a stronger association seen for jowar and other millets (Kodo millet, little millet, proso millet, barnyard millet and foxtail millet). District level stunting was associated with higher district level cultivation of all crops (except other millets). The analysis was limited by lack of fine-scale data on prevalence of low birth-weight and type of cereal consumed. Conclusions: Better cereal cultivation and consumption data will be needed to confirm causal pathways contributing to potential ecogeographic patterns. The cultivation of other millets has a strong association with prevalence of wasting. State-of-the-art studies that improve our understanding of bio-availability of amino acids and other nutrients from the prevalent dietary matrices of rural poor communities will be needed to confirm causal pathways contributing to potential eco-geographic patterns.
Article
Accumulating evidence suggests that amino acids are important indicators of nutritional and metabolic status. A high‐resolution MS method based on sequential window acquisition of all theoretical mass spectra acquisition was developed for the simultaneous determination of 16 amino acids in human plasma. Sample preparation by protein precipitation using a mixture of acetonitrile and formic acid was followed by a BEH Amide column. The superiority of this method was investigated by comparing to TOF scan and multiple reaction monitoring modes. The limit of detection in SWATH mode for threonine, methionine, histidine, citrulline and tryptophan is 0.1 ng on column; for lysine and asparagine is 0.2 ng; for alanine, pyroglutamic acid, leucine, ornithine and aspartate is 0.5 ng, for arginine is 1.0 ng; for glutamate and serine is 2.0 ng; for glutamine is 10.0 ng. This method was linear in the range 0.8–40 μg/mL for arginine, citrulline, glutamate, histidine, leucine, methionine, pyroglutamic acid, threonine, tryptophan; 2–100 μg/mL for asparagine, aspartate, lysine, ornithine, serine; and 4–200 μg/mL for alanine, glutamine with good accuracy and precision. Significantly different levels in 11 amino acids were observed between childhood and adulthood, representing the growth and development of individuals relating to the level of amino acids. This article is protected by copyright. All rights reserved
Article
Full-text available
Dietary protein and amino acid requirement recommendations for normal "healthy" children and adults have varied considerably with 2007 FAO/WHO protein requirement estimates for children lower, but dietary essential AA requirements for adults more than doubled. Requirement estimates as presented do not account for common living conditions, which are prevalent in developing countries such as energy deficit, infection burden and added functional demands for protein and AAs. This study examined the effect of adjusting total dietary protein for quality and digestibility (PDCAAS) and of correcting current protein and AA requirements for the effect of infection and a mild energy deficit to estimate utilizable protein (total protein corrected for biological value and digestibility) and the risk/prevalence of protein inadequacy. The relationship between utilizable protein/prevalence of protein inadequacy and stunting across regions and countries was examined. Data sources (n = 116 countries) included FAO FBS (food supply), UNICEF (stunting prevalence), UNDP (GDP) and UNSTATS (IMR) and USDA nutrient tables. Statistical analyses included Pearson correlations, paired-sample/non-parametric t-tests and linear regression. Statistically significant differences were observed in risk/prevalence estimates of protein inadequacy using total protein and the current protein requirements versus utilizable protein and the adjusted protein requirements for all regions (p < 0·05). Total protein, utilizable protein, GDP per capita and total energy were each highly correlated with the prevalence of stunting. Energy, protein and utilizable protein availability were independently and negatively associated with stunting (p < 0·001), explaining 41 %, 34 % and 40 % of variation respectively. Controlling for energy, total protein was not a statistically significant factor but utilizable protein remained significant explaining~45 % of the variance (p = 0·017). Dietary utilizable protein provides a better index of population impact of risk/prevalence of protein inadequacy than crude protein intake. We conclude that the increased demand for protein due to infections and mild to moderate energy deficits, should be appropriately considered in assessing needs of populations where those conditions still prevail.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.