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Energyandproteinrequirements

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6.3Infants,children,andadolescents
6.3.1Energyrequirements
Although,inprinciple,itwouldbedesirabletodeterminetherequirementsofchildren,inthesamewayasforadultsfrom
measurementsofenergyexpenditure,thisapproachinvolvesmanydifficultiesinpractice.InformationisindeedavailableontheBMRs
ofchildrenofallagesforwhichpredictionequationsaregiveninTable5.However,inyounginfants,inwhomtherequirementfor
growthisasubstantialcomponentofthetotalrequirementforenergy,therearelargevariationswithinthenormalrange,intherateof
growth,andprobablyalsointhecompositionofthetissuelaiddown.Moreover,forbothinfantsandchildren,itisnotpossibletospecify
withanyconfidencetheallowancethatshouldbemadeforadesirablelevelofphysicalactivity.Wehavethereforefollowedtheexample
ofthe1971Committee(la)andestimatedtheenergyrequirementsfrombirthto10yearsfromtheobservedintakesofhealthychildren
growingnormally.
6.3.1.1Infants(birthto12months).Upto6monthsofagethe1971Committee(la)usedtheresultscollectedbyFomonetal.(55)for
theintakesofinfantsfedbreastmilkbybottle.Forolderchildren,theyusedfiguresfortheintakesofchildrenintheUnitedStatesof
AmericaandtheUnitedKingdompresentedbyLeitch&WiddowsontothesecondFAOCommitteeonCalorieRequirements(56).A
muchlargercollectionofinformationisnowavailableontheintakesofinfants,children,andadolescentscompiledfromstudiesin
Canada,Sweden,UK,andUSA(57).Resultsfromdevelopingcountrieswerenotincludedinthisanalysistoensurethattheintakes
representthoseofgroupsofchildrenwho,onaverage,weregrowingalongthe50thcentileoftheWHOreferencestandard.Forthe
first12monthstherearesome4000datapointsavailable.Themeansofthemeasuredintakesateachmonthforthefirstyearare
giveninTable21.Thattableshowsafallinenergyintakeperkgofbodyweightbetween3and6monthswhichismaintaineduntil9
months,andthenrisesagaintowards1year.Webelievethisreductiontobearealphenomenon,representingaperiodwhenthevery
highgrowthratecharacteristicofthefirst3monthsoflifehasdeclinedbutisnotyetbalancedbyincreasedphysicalactivity.

Table21.Calculatedenergyrequirementsofinfantsfrombirthto1year
Age

Intakea

(months)

(kcalth/kg
perday)

0.5
12
23
34
45
56
67
78
89
910
1011
1112
12

118
114
107
101
96
93
91
90
90
91
93
97
102

Calculatedenergy
requirementb

Medianbodyweightc

Totalrequirement

(kJ/kg
perday)

(kcalth/kg
perday)

(kJ/kg
perday)

Boys
(kg)

Girls
(kg)

Boys
(kcalth/day)

(kJ/day)

Girls
(kcalth/day)

(kJ/day)

494
477
448
423
402
389
381
377
377
381
389
406
427

124
116
109
103
99
96.5
95
94.5
95
99
100
104.5

519
485
456
431
414
404
397
395
397
414
418
437

3.8
4.75
5.6
6.35
7.0
7.55
8.05
8.55
9.0
9.35
9.7
10.05

3.6
4.35
5.05
5.7
6.35
6.95
7.55
7.95
8.4
8.75
9.05
9.35

470
550
610
655
695
730
765
810
855
925
970
1050

1965
2300
2550
2740
2910
3055
3220
3390
3580
3870
4060
4395

445
505
545
590
630
670
720
750
800
865
905
975

1860
2115
2280
2470
2635
2800
3010
3140
3350
3620
3790
4080

aObservedintakesatagesindicated,fromdataofWhiteheadetal.(57),omittingstudies7andF bontechnicalgrounds.Averageintakepredictedfromequation(ageinmonths):I
(kcalth/kg)=1238.9age+0.59age2.
bRequirementoverintervalindicated,calculatedaspredictedintake+5%(seetext).
cNCHSmedianweightsatmidpointofmonth.

Table22.Energyrequirementsofinfants:comparisonofpresentestimateswiththoseofthe1971Committee(1a)
Age
(months)

Present
(kcalth/kg)

1971

03
36
69
912
Averageduringfirstyear

116
99
95
101
103

120
115
110
105
112

Present

1971

(kJ/kg)
485
415
400
420
430

500
480
460
440
470

Theintakesofthebreastfedinfantsinthesestudiesweremeasuredbytestweighing.Recentmeasurementsofbreastmilk
consumptionbythedeuteriumoxidemethodsuggestthattestweighingunderestimatesactualmilkconsumptionbyabout5%(58).
Estimatesoftheintakeofotherfoodsarelikelytohaveasimilarbias.TheConsultationthereforeacceptedthattheestimatesofthe
energyrequirementsofinfantsshouldbesetat5%abovetheaverageobservedintakes.Thefiguresthatresultarestill1015%lower
thanthoseproposedbythe1971Committee(1a)(Table22).
6.3.1.2Children110years.Inordertocalculatetheenergyrequirementsofchildrenover1yearofagefrommeasurementsofenergy
expenditure,boththetimeandcostofalltypesofphysicalactivityneedtobeknown.Unfortunately,thisinformationisnotavailablefor
childreninthisagegroup,anditisthereforenecessary,asforinfants,toevaluatetheirenergyrequirementsfromdataondietaryintake.
Table23showsthemeanintakesofboysandgirlsfrom1to10years.Thesevaluesarederivedfromacriticalreviewoftherecent
literature,1andarebasedonstudiesindevelopedcountriesandinthemoreaffluentgroupsofdevelopingcountries.Theregression
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equationswerecalculatedfrom6500datapointsforgirlsand6000forboys.
1FerroLuzzi,A.&Durnin,J.V.G.A.Theassessmentofhumanenergyintakeandexpenditure:acriticalreviewoftherecentliterature.Rome,FAO,1981(DocumentESN:
FAO/WHO/UNU/EPR/81/9).

Table23showsthatafter34yearstheestimatedintakesfallbelowtherequirementsforchildrenproposedbythereportofthe1971
Committee(la).Themeaningofthismaybethatphysicalactivity,andthustheenergyrequirementofchildren,hasdeclinedinrecent
times,reflectingincreasinglysedentarylifestylesinthelargecitiesofindustrializedcountries.Thereissomeevidenceofthisinolder
children(60).Iftrue,suchareductionmaywellbeconsideredundesirablefromthepointofviewofoptimalhealthandfunction,as
maintenanceofadequatelevelsofphysicalactivityisthoughttobenecessaryintheformativeyearsofthegrowingchild.Thereforethe
Consultationconsideredthatrecommendationsforthisagegroupshouldbebasedonobservedintakes,butthattheyshouldbe
increasedby5%toallowforadesirablelevelofphysicalactivity.
Littleinformationisavailableintheliteratureontheenergyintakesofchildreninthedevelopingcountries,whomaybeexpectedtolead
amoreactivelife,havingtowalklongdistances,undertakinghardphysicalwork,sometimesbeinglesstiedtosedentaryactivitiesby
strictschoolschedules,etc.Theirenergyintakesaresmallerthanthoseoftheircounterpartsofthesameageindevelopedcountries,
butthedifferencelargelydisappearswhentheintakesarerecalculatedonabodyweightbasis.Onemightpostulatethatinthiscase,
externallyimposedlimitationsmayrestrictbothenergyintakesandenergyexpenditure.Theextra5%addedtoobservedintakesmay
beconsideredarealisticestimateoftherequirementifenoughenergyistobeavailableforadesirablelevelofphysicalactivity.
6.3.1.3Children1017years.After10yearsofageitbecomesfeasibletobaserequirementsonestimatesofenergyexpenditurebuilt
upbythefactorialmethod.Theapproachisbasicallythesameasforadults.
Asinadults,theBMRinchildrenisgenerallythelargestcomponentoftherequirement.Becauseofdifferencesinthetimingofthe
pubertalgrowthspurt,bothweightsandheightsatanygivenagearerathervariable.Forexample,in12yearoldboys,weightmay
varyfrom28kg(3rdcentile)to59kg(97thcentile),andheightfrom1.36to1.64m.ThebestpredictoroftheBMRisweightand,asin
adults,theBMRperkgvarieswithbodyweight.Atanygivenweight,variationsinheightmakenodifferenceinboysandonlyasmall
differenceingirls(atagivenweightthepredictedBMRchangesbylessthan5%asonemovesfromthemedianheighttothe3rdor
97thcentiles,Annex1).Asdiscussedinsection3.5.1,theBMRmaybeestimatedeitherfromtheactualweightorfromthemedian
weightforheightandage,asshowninBaldwin'stable(Annex2(B)).ValuesfortheBMRofadolescentsatmedianweightforheight
andagearegiveninTable24.

Table23.Estimatedaveragedailyenergyintakesandrequirementsofchildrenaged110years,comparedwithestimatesof
1971Committee(1a)
Boys

Requirementbyweightc

Girls
a

Age

Requirement

Intake

Present

Requirement

Intake

1971

Present

1971

(years) (kcalth/day) (MJ/day) (kcalth/day) (MJ/day) (kcalth/day) (MJ/day)

(kcalth/
(kcalth/
(kcalth/
(MJ/day)
(MJ/day)
day)
day)
day)

12
23
34
45
56
67
78
89
910

1090
1250
1370
1465
1550
1620
1685
1740
1795

1140
1340
1490
1610
1720
1810
1895
1970
2045

4.76
5.60
6.23
6.73
7.19
7.57
7.92
8.24
8.55

1200
1410
1560
1690
1810
1900
1990
2070
2150

5.02
5.89
6.52
7.07
7.57
7.94
8.32
8.66
8.99

1180
1360
1560
1720
1870
2010
2140
2260
2380

4.93
5.69
6.52
7.19
7.82
8.40
8.95
9.45
9.95

4.56
5.23
5.73
6.12
6.48
6.77
7.05
7.28
7.51

1140
1310
1440
1540
1630
1700
1770
1830
1880

4.76
5.48
6.02
6.44
6.81
7.11
7.40
7.65
7.86

1180
1350
1520
1670
1790
1900
2010
2110
2110

Boys

Girls

(kcalth/
(kcalth/kg (kJ/kg
(MJ/day)
per
kgper
perday)
day) day)
4.93
104
435 108
5.64
104
410 102
6.35
99
414 95
6.98
95
397 92
7.48
92
385 88
7.94
88
368 83
8.40
83
347 76
8.82
77
322 69
8.82
72
301 62

(kJ/kg)
per
day)
452
427
397
385
368
347
318
268
259

aFromdataofFerroLuzzi&Durnin(seefootnote1onpage92).
bIntakes+5%(seetext).
cFromNCHSmedianweightsatmidyear.

Table24.Basalmetabolicratesofadolescentboysandgirls
(years)

Heighta
(cm)

Weightb
(kg)

Boys

140
147
153
160
166
171
175
177

142
148
155
159
161
162
163
164

Age

1011
1112
1213
1314
1415
1516
1617
1718
Girls
1011
1112
1213
1314
1415
1516
1617
1718

BMRc
total
(kcalth/day)

(MJ/day)

perkg
(kcalth/day)

(MJ/day)

32.2
37.0
40.9
47.0
52.6
58.0
62.7
65.0

33.7
38.7
44.0
48.8
51.4
53.0
54.0
54.4

1215
1300
1370
1465
1570
1665
1750
1790

1160
1220
1280
1340
1375
1395
1405
1410

5.08
5.43
5.73
6.12
6.57
6.96
7.32
7.48

4.85
5.10
5.38
5.60
5.75
5.83
5.87
5.89

37.7
35.1
33.4
31.4
29.9
28.7
27.9
27.5

34.3
31.5
29.1
27.5
26.7
26.3
26.0
25.9

0.16
0.15
0.14
0.13
0.12
0.12
0.12
0.12

0.14
0.13
0.12
0.12
0.11
0.11
0.11
0.11

aMedianheightforagefromNCHSstandards.

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bMedianweightforheightandagefromBaldwin'sstandards(Annex2(B)).
cBoys:BMR=17.5W+651kcal /day(2.72MJ/day).Girls:BMR=12.2W+746kcal /day(3.12MJ/day).
th
th

Forgrowth,anadditionof5kcalth(21kJ)pergisallowedfortheaveragedailycostofweightgain(61).Itisrecognizedthatgrowth
doesnotoccurataregularratefromdaytoday(section3.2).However,evenduringthepubertalspurttherequirementforgrowthisso
smallcomparedwiththetotalenergyrequirementthatnoextraallowanceintheenergyintakeneedbemadeforthisvariability.
Inordertoillustratequantitativelytheenergyrequirementsfordifferentpatternsofactivity,anattemptwasmadetoidentifythetimethat
mightbespentbyeachsexandagegroupsleeping,goingtoschool(includinghomework),andundertakinglight,moderate,andheavy
physicalactivity.Thereislittleinformationintheliteratureontheamountoftimechildrenandadolescentsspendondifferenttypesof
activity,buttheseareboundtobehighlyvariable.Thetimeallocationswereestimatedasthedailymeansthroughouttheyear,
assumingthattheaveragechildstillgoestoschoolattheageof10.Itwasalsoassumedthatthechildbeginssecondaryschoolatthe
ageof13.Insocietieswherechildrenbeginworkratherthangotosecondaryschool,patternsofactivityshouldbecalculated
accordingly.
ThevaluesshowninTable25representthebestestimatesoflevelsofactivityatdifferentagesthatwouldbecompatiblewithagood
rateofgrowthandoptimaldevelopmentandhealthinchildrenofappropriateweightandheightfortheirage.
Incalculatingenergyexpenditure,ithasbeenassumedthattheenergycostofsleepisequaltotheBMR.Estimatesoftheadditional
energycostsofotheractivities,overandabovetheBMR,werebasedupontheprinciplesdescribedinsection4.Thegrossenergy
costswereassessedasfollowsintermsofBMRunits:

Goingtoschoolandlightactivity
Moderateactivity
Highactivity

Boys
1.6BMR
2.5BMR
6.0BMR

Girls
1.5BMR
2.2BMR
6.0BMR

Thesomewhatlowervaluesgivenforgirlsassumethattheirintensityofactivitywoulddeclinetothelevelfoundinadultwomen(see
section6.2).
Table26showsanexampleofhowenergyexpenditurewascalculatedfromtimedactivitiesofa10yearoldboyinadeveloping
country.Table27showsasimilarbutlessdetailedcalculationforagirlinanindustrializedcountry.Thecalculationsforbothsexesand
forages1017yearsareshowninAnnex7.Table28shows,foreachagegroup,valuesforenergyneedsbasedinthiswayonan
estimateofenergyexpenditureplustheincrementforgrowth,togetherwiththerelationshiptoBMR.TheBMRfactorvariesovera
rathernarrowrange,fromabout1.6to1.75inboysandfrom1.5to1.65ingirls.
Thenewestimatesofenergyrequirements,basedoncalculatedenergyexpenditure,arecomparedinthetablewithobservedenergy
intakesofadolescents.The1971Committee'srecommendations(1a)arealsoshowntoserveasareference.Itisobviousthatthenew
estimatesareappreciablyandconsistentlylowerthanthoseproposedbythatCommitteeandthattheobservedvaluesofenergy
intakesarelowerstill.Between10and18yearsthenewestimatesofenergyrequirementsofboysexceedtheactualfiguresof
observedenergyintakesbyanamountthatcorrespondsalmostexactlywiththeamountofenergythoughtdesirableforchildrento
spendinhighactivity(hourat6.0BMR).Ingirlsthediscrepancyisgreater,presumablyreflectingalowlevelofphysicalactivityin
thesamplewhoseintakesweremeasured.TheConsultationconsideredthattheestimatedrequirementsforthisagegroupshouldnot
bedecreasedtomatchtheobservedintakesinaffluentcountries.Fulfilmentoftherequirementsasproposedislikelytobebeneficialif
physicalactivityisincreased,andindevelopingcountrieswillprovideamarginofsafety.

Table25.Estimatedtimeallocation(hoursperday)usedinthecalculationofenergyrequirementsofadolescents
Age(years)
1011
1112
1213
1314
1415
1516
1617
1718

Sleep
9
9
9
9
8
8
8
8

Schoola
4
5
5
5
6
6
6
6

Activity
Light
4
4
5
6
7
7
7
7

Moderate
6.5
5.5
4.5
3.5
2.5
2.5
2.5
2.5

High
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5

aAverageoverwholeyear.

Table26.Exampleofthecalculationofthedailyenergyexpenditureofa101/2yearoldboyinadevelopingcountry
(bodyweight=32.2kg)
Activity

hours

kcalth

kJ

Sleepat1.0BMRa
Schoolat1.6BMR
Lightactivityat1.6BMR:
sitting,standing,movingaround
socialactivities,washing,play
Moderateactivityat2.5BMR:
walking,householdtasks,agriculturaltasks,play
Heavyactivityat6.0BMR:
fetchingwoodandwater,agriculturaltasks
Growth
Totalrequirementper24hours
=1.71BMR

455

1900

2.5

6.5
2

200

525
160

380

300
60
2080

840

2200
670

1590

1260
250
8710

aBMRestimatedtobe1215kcal /day(5080kj/day).
th

Table27.Exampleofthecalculationusedtoderiveenergyexpenditureina10yearoldgirl(bodyweight=33.8kg)
Activity
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kcalth

kJ

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Sleepat1.0BMRa
Schoolat1.5BMR
Lightactivityat1.5BMR
Moderateactivityat2.2BMR
Highactivityat6.0BMR
Totalexpenditure
Growth
Totalrequirementper24hours
=1.65BMR

kcalth

kJ

435

1820

4
4
6.5
0.5

290
290
690
145
1850
65
1915

1210
1210
2890
610
7740
270
3010

aBMRestimatedtobe1160kcal /day(4850kJ/day).
th

Table28.Comparisonofcalculatedaverageenergyexpenditure,observedintakes,andrecommendationsof1971
Committeeforadolescentsaged1018years
Age

Expenditure

(BMR)a

(years)
Boys
1011
1112
1213
1314
1415
1516
1617
1718
Girls
1011
1112
1213
1314
1415
1516
1617
1718

Expenditure

(kcalth/day)

1.76
1.73
1.69
1.67
1.65
1.62
1.60
1.60

1.65
1.63
1.60
1.58
1.57
1.54
1.53
1.52

2140
2240
2310
2440
2590
2700
2800
2870

1910
1980
2050
2120
2160
2140
2130
2140

Intakeb

(kcalth/day)

(MJ/day)

8.95
9.37
9.66
10.20
10.83
11.29
11.71
12.0

7.99
8.28
8.57
8.87
9.03
8.95
8.91
8.95

2110
2170
2200
2280
2340
2390
2440
2490

1850
1890
1930
1970
2010
2050
2080
2120

1971Committeec
recommended
requirement
(MJ/day)

8.82
9.07
9.20
9.53
9.79
9.99
10.20
10.41

7.74
7.90
8.07
8.24
8.40
8.57
8.70
8.87

(kcalth/day)

2500
2600
2700
2800
2900
3000
3050
3100

2300
2350
2400
2450
2500
2500
2420
2340

(MJ/day)

10.46
10.87
11.29
11.71
12.13
12.55
12.76
12.97

9.62
9.83
10.04
10.25
10.46
10.46
10.12
9.79

aExpenditurecalculatedasinTables26and27Annex7.BMRfromequationsinTable5.
bIntakesfromreference(62).
cReference(1a).

6.3.2Proteinrequirements
6.3.2.1Infantsfrombirthto6months.Asinthecaseofenergy,the1971Committeebaseditsestimateoftheproteinrequirementsfrom
birthto6monthsonintakedatabecauseofthedifficultiesofaccuratelyallowingforgrowthandmaturation.Manyobservationsshow
thatinfantsbreastfedbyhealthywellnourishedmothers(6265)orfedbreastmilkbybottle(55)cangrowatasatisfactoryratefor46
monthsusingthestandardsadoptedinthisreport.Itmaythereforebeconcludedthatforthefirst6monthsoflifetheproteinneedsof
aninfantwillbemetifitsenergyneedsaremetandthefoodprovidingtheenergycontainsproteininquantityandqualityequivalentto
thatofbreastmilk.
Theaverageproteincontentofhumanmilk,calculatedastotalN6.25,hasbeentakenas1.15gper100mlafterthefirstmonthof
lactation1.Itisrecognizedthathumanmilkcontainsabout40mgofnonaminonitrogenper100ml(approximately20%oftotalN)(66,
68)but,followingtheusualconvention,wehaveassumedthatthisnitrogenfractionisutilized.Iftheaverageenergycontentistakenas
70kcalth(290kJ)per100ml,theproteincontentis1.64gper100kcalth(6.85gperMJ).

Table29.Averageintakeofproteinbybreastfedinfantsaged04months
Age
(months)
Boys
01
12
23
34
Girls
01
12
23
34

Breastmilk
consumeda
(ml)

719
795
848
822

661
731
780
756

Proteinintakea

Weightb

Average
proteinintake

(g/day)

9.35
9.15
9.75
9.45

8.6
8.4
9.0
8.7

(kg)

3.8
4.75
5.6
6.35

3.6
4.35
5.05
5.7

(g/kgperday)

2.46
1.93
1.74
1.49

2.39
1.93
1.78
1.53

Average
1971Committeec
(g/kgperday)

2.40
1.91
1.71
1.64

aFromTable20.InaccordancewiththefindingsofWallgren(69)andWhitehead(63),thebreastmilkconsumptionbyfemaleinfantsistakenas8%lessthanthatofmaleinfants.
bNCHSmedian,midpointofmonths.
cFromreference(1a),Table15(dataofFomon).

Anestimateoftheaverageproteinintakeperkginbreastfedinfantsupto4monthsisshowninTable29.Althoughtheamountofmilk
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consumedbyinfantgirlsislessthanthatbyboys,onabodyweightbasistheintakesarevirtuallythesame.Forcomparison,thetable
alsoshowstheaverageproteinintakesofinfantswhowerefedbreastmilkbybottle(55).Thesewerethedataonwhichthe1971
Committeebaseditsestimatesofproteinrequirementsforinfantsupto6monthsold.
1Thevaluesadopted,1.15goftotalNand70kcal (290kJ)per100mlofhumanmilkarebasedonthecompilationsofMacy(66),theDepartmentofHealthandSocialSecurity,
th
UnitedKingdom(52),andtheWHOCollaborativeStudyonBreastfeeding(67).

Estimatesoftheproteinintakeofbreastfedinfantsarenotshownaftertheageof4months,becausefromthisagethereisinsufficient
informationontheintakesofexclusivelybreastfedinfantswhoaregrowingsatisfactorily.Itmaybenotedthatiftheestimatesofenergy
requirementsshowninTable21arecorrect,itwouldneed1040mlofbreastmilktofulfiltheenergyneedsofamaleinfantat56
months.Thisvolumeislargerthanhasusuallybeenobserved.
Forthepurposeofcomparisonwitholderinfants,itmaybenotedthatiftheaveragedailyenergyintakeat6monthsis95kcalth(400
kJ)perkg(Table22),thecorrespondingaverageproteinintakefrombreastmilkwillbe1.56gperkgperday.
6.3.2.2Childrenfrom6monthsonwards.Theperiodfrom6to12monthsisclearlythemostcritical,becauseofrapidgrowthduringthis
timeandbecausethechildincreasinglyreliesonsupplementaryfoods.Thefirstprioritymustthereforebetoestablishasreliablean
estimateaspossibleofthesafelevelofproteinintakeforchildrenofthisage.Onecanthenwithsomeconfidenceinterpolatethesafe
levelforolderchildrenfromthisestimate.
Theproteinrequirementsofchildrenhavebeencalculatedinthefirstinstancebyamodifiedfactorialmethod.Aswithadults,andwith
thesamelimitations,themaintenancerequirementscaninprinciplebeestimatedfrommeasurementsofnitrogenbalanceatseveral
levelsofintake.ThereistheadditionalproblemofdetermininganappropriatevaluefortheNretainedduringgrowthandthe
requirementforachievingthisretention.
(a)Maintenancerequirement.SeveralshorttermNbalancestudieshavebeencarriedoutinolderinfantsandyoungchildrento
determinetheproteinrequirementbythesloperatiomethod(seesection5).Thesehavebeenhealthychildren,usuallyrecoveredfrom
malnutrition,shortinstaturebutinthenormalrangeofweightforheight.Theusualdesignfollowsthatofadultstudies:energyintakeis
keptconstantatalevelassumedtobeadequateandproteinisgivenatdifferentlevels,eachforaperiodofseveraldays.Fromthese
studiesitispossibletocalculateamaintenancerequirement(nogrowth,Nequilibrium)fromtheregressionofNbalanceonNintake,
allowing10mgofNperkgperdayforsweatandmiscellaneousNlosses.Intheoryitisalsopossiblefromthesestudiestodetermine
theamountofproteinneededinthediettomeetanychosenvalueforNretention.
TheresultsinTable30indicatethatinthecriticalagegroupfrom6to20months,withmilkasasourceofprotein,theaverage
maintenancerequirementisapproximately115120mgofNperkgperday.Studiesofadifferentdesign,inwhichNbalancewas
measuredonlyonceortwiceineachchildoverarangeofintakes,gaveamaintenancerequirementof110mgofNperkgperday(75).

Table30.Resultsofseveralshorttermbalancestudiesaonyoungchildrenofdifferentages

620months

1731months

3862months

1a
Milk
24

2a
Egg
10

3a
Milk
10

4a
Soy
10

5a
Rice,fish
7

6a
Milk
7

7a
Soy
7

8a
Mixed
3

Proteinsource
No.ofchildren
Intakerange(/kg/day)
Energy(kcalth)

6192

6988

100

100

110

100

100

100

(kJ)
N(mg)
Slope

255385
16173
0.69

290370
71150
0.71

420
80320
0.74

420
80320
0.61

460
120320
0.54

420
120240
0.53

420
120240
0.51

420
160320
0.44

Averagemaintenancerequirementb
(mgN/kgperday)

117

120

80

98

130

91

137

164

117

117

80

97

98

91

100

118

Correctedfordigestibility

aColumn1=reference(70)column2=reference(70)column3=reference(71)column4=reference(71)column5=reference(72)column6=reference(73)column7=
reference(73)column8=reference(74).
bAllowing10mgofN/kgforskinlosses.
cCorrectedfordigestibilityofmilk,whereappropriate.

Theresultsofthebalancestudiesintheolderagegroupsaresomewhatvariable.Theestimatedmaintenancerequirement,corrected
tothedigestibilityofcow'smilk,rangedfrom80to118mgofNperkgperday.Sincetheaveragemaintenancerequirementinyoung
adultsstudiedinshorttermbalanceswasestimatedat98mgofNperkgperday(section6.1.2),itseemsreasonable,forintermediate
agegroups,tointerpolatebetweentwowellestablishedvalues.These,roundedoff,wouldbe120mgofNperkgperdayat1year,
fallingto100mgofNperkgperdayat20years.
Inthebalancemeasurementsonchildrentherangeofinterindividualvariationintheestimateofthemaintenancerequirementwas
similartothatfoundinthemuchmorenumerousshorttermbalancesinadults,andtheConsultationhasthereforeacceptedthesame
valueof12.5%forthecoefficientofvariationofthemaintenancerequirement.
Itisassumedthatthisrepresentsvariabilityintheefficiencyofutilizationanassumptionthatisimportantwhentherequirementfor
growthisbeingconsidered.
(b)Therequirementforgrowth.ThemeanrateofNaccretionduringgrowthcanbeestimatedfromtheexpecteddailyrateofweight
gain(NCHS50thcentile)andtheNconcentrationinthebody.Thisislowatbirth,andincreasestotheadultvalueby5yearsofageor
earlier.Theextentoftheincreaseisimportantbetween6and12months,whengrowthisrapid.The1971Committee(1a)reported
valuesforbodyNconcentrationatdifferentagesobtainedbythreedifferentmethods.Atsomeagesthevalueswerenotingood
agreement.
MorerecentestimatesofNaccretionduringgrowthhavebeenprovidedbyFomonetal.(76).Theyaresimilartothoseacceptedbythe
1971Committee(la,Table12)butlowerthansomeearlierestimates(77).
However,aspointedoutinsection3.2.1,itshouldnotbeassumedthatgrowthalwaysproceedsatexactlythesameratefromdayto
day,eveninapparentlyhealthychildren.Thecause,extent,andsignificanceofthesefluctuationsingrowthratearedifficulttoassess.
Table31illustratestheextentofvariationinweightgainthathasbeenobservedoveraperiodof4weeksinhealthychildrenaged46
months(78andS.J.Fomon,personalcommunication).
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Table31.Variabilityofweightgainandenergyintake(expressedasaveragedailyrates)overonemonthintervalsinboys
aged31/261/2monthsa

Weightgain(g/day)
10thcentile
50thcentile
90thcentile
mean
SD
CV(%)
Weightgaing/100kcalth(g/1000kJ)

Period(daysofage)
112140

9.8
17.5
25.8
17.7
6.9
39

140168

9.0
17.6
25.3
17.6
7.1
40

168196

5.0
14.8
20.8
14.1
6.4
45

10thcentile
50thcentile
90thcentile
mean
SD
CV(%)
Energyintakekcalth/day(kJ/day)

1.7(4.1)
2.5(6.0)
3.8(9.1)
2.6(6.2)
1.0(2.4)
38(90.8)

1.3(3.1)
2.5(6.0)
3.4(8.1)
2.4(5.7)
1.0(2.4)
42(100)

0.8(1.9)
2.1(50.2)
3.0(7.1)
2.0(4.8)
0.9(2.2)
45(107.6)

10thcentile
50thcentile
90thcentile
mean
SD
CV(%)

78(326)
95(397)
115(481)
96(402)
14(59)
15(63)

74(310)
95(398)
114(477)
96(407)
15(63)
16(67)

72(301)
89(372)
109(456)
90(377)
15(63)
17(71)

aUnpublisheddataofFomon.

Thevariabilityofgainismuchgreaterthanthevariabilityofintake,sothatpresumablyitresultstoalargeextentfromvariationinthe
efficiencyofutilizationoffoodforgrowth.
LongitudinalstudiesinJamaicaonreasonablyhealthyandwellnourishedchildrenshowedthatoversuccessivemonthsaperiodof
falteringwouldusuallybefollowedbyaperiodofweightgainat23timesthenormalrate(79).Verylittleisknownaboutvariationsover
shorterperiods.Dailymeasurementsofchildren'sweightsevenunderstandardizedconditionsinametabolicwardshowfluctuations,
whichnodoubtresultedpartlyfromdifferencesintheamountsofurineandstoolretainedatthemomentofweighing.
Theymayalsorepresentdifferencesfromdaytodayintheproportionsoffatandleantissuelaiddown.Itisknownthatindividual
children,atleastwhenrecoveringfrommalnutrition,maydifferwidelyinthecompositionofweightgain(80).
Ifitisacceptedthatdifferentamountsofproteinmaybelaiddownfromdaytoday,aspartofthenormalprocessofgrowth,the
questionthenarises,whatistheeffectofthisonthechild'sdailyproteinrequirement?Inordertomaintainasatisfactoryoverallrateof
growth,anyfailuretolaydownproteinononedaymustbecompensatedforonasubsequentday.Studiessuchasthosecitedin
section5suggestthatthebodyhasaverylimitedcapacityforstoringaminoacidsorfordrawingonthefreeaminoacidpoolforprotein
synthesis.Evenduringshortperiodssuchas12hourswithoutfood,nitrogenbalancebecomesnegative(81).Therefore,inaccordance
withclassicalteaching,itseemsveryunlikelythataminoacidsprovidedonadaywhentherewasnogrowthcouldbeheldinstockto
beutilizedforgrowthlateron.Itfollowsthatsinceitisimpossibletoforetellonwhichdaysthegrowthratewillbeloworhigh,itis
necessarytoprovideenougheverydayforapossibleextrademand.
Thereisnoevidenceavailableonwhichtobasearealisticestimateoftheextrarequirementforproteinthatmightariseinthisway.In
thissituationajudgementhastobemade.Areasonablejudgementmustleadtoestimatesthataresimilartovaluesestablished
independently,suchastheintakesofhealthybreastfedchildren.Itwasfoundthatif,inthefactorialcalculationthegrowthcomponentof
theproteinrequirementissetat50%abovethatbasedonthetheoreticaldailyamountofNlaiddown,thecalculatedaverage
requirementat4monthscomesclosetotheaverageintakeofbreastfedinfants(Table32).Toprovideaphysiologicalmarginofsafety,
itwasthereforedecidedtoincreasethetheoreticalgrowthrequirementbyafactorof50%.

Table32.Averageproteinrequirementsofinfantscalculatedbythefactorialmethod,comparedwithaverageintakesfrom
breastmilka
Age
(months)
12
23
34
45
56
69
912

N
incrementb

N
incrementc
1.5

(mgN/kgperday)
112
168
80
120
55
81
44
66
41
62
37
56
30
45

Corrected
forefficiencyd

Maintenancee

Total

240
171
116
94
89
80
64

120
120
120
120
120
120
120

360
291
236
214
209
200
184

Total
asprotein

Intakefrom
breastmilkf

(gprotein/kgperday)
2.25
1.93
1.82
1.74
1.47
1.49
1.34

1.30

1.25

1.15

aAlthoughbodyweightsdifferbetweenmaleandfemaleinfants,itisnotconsideredthatrequirementsperkgwilldiffer.
bFromreference(76).
cSeetext.
dEfficiencyofutilizationassumedtobe70%.
eSeetext.
fFromTable29.

TheamountofdietarynitrogenneededtoallowforagivenamountofNdepositedcanbederivedfromthesameslopeasthe
requirementformaintenance.Itisassumedthatdietaryproteinisusedwiththesameefficiencyforgrowthasitisformaintenance,and
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ontheoreticalgroundsthereisnoreasontosupposethatthisassumptionisnotvalid(section5.4).Theappropriateslopefordiets
basedonmilkoregghasbeentakenas0.7atallages.
Table32showsthedetailedcalculationoftheaveragerequirementofproteinforinfantsupto1year,overtheperiodwhengrowth
makesasignificantcontribution.Althoughthefactorialmethodisnot,infact,usedforinfantsbelowtheageof6months,the
calculationshavebeenmadeinordertocomparetheresultswiththeestimatedproteinintakesfrombreastmilk(Table29).This
comparisonsuggeststhattheproposedadditionof50%tothenitrogenincrementdoesnotunrealisticallyincreasetheestimate,andit
mayevenbetoosmall.Thisisasubjectonwhichmoreresearchisurgentlyneeded.
Finally,acorrectionhastobemadefortheinterindividualvariabilityofgrowth,inordertoarriveatasafelevelofproteinintakefor
virtuallyallhealthychildren.ThecoefficientsofvariationshowninTable31representamixtureofinterandintraindividualvariability
overperiodsof4weeks.Thisintervalshouldbelongenoughtosmoothouttheeffectsofdaytodayfluctuationsinthegrowthofeach
individualchild,asdiscussedabove.Itisapparentthatoveraperiodofamonthchildrendovaryintheiraveragedailyrateofgrowth,
withaCVofapproximately37%.TheCVwillbeloweroverlongerperiodsandhigherovershorterperiods.IftheonemonthCVis
acceptedasareasonablecompromise,anoverallCVcanbecalculated,asshowninthefootnotetoTable33.Thisis15%at69
months,fallingto12.5%inthesecondyear.Thedatadonotjustifymoredetailedestimates.
Itisapparentthat,atpresent,wedonothaveanadequatetheoreticalbasisforcalculatingthevariabilityoftheproteinrequirementfor
growthinyoungchildren,amajorproblembeingthatthisvariabilitydependsonthelengthoftheperiodoverwhichthegrowthis
measured.Itishopedthatthisdiscussionoftheproblemwillstimulatefurtherresearch.
TheestimatedsafelevelscalculatedinthiswayareshownforchildreninTable33,andforadolescentsinTable34,andcomparedwith
thoseofthe1971Committee(la).Inadolescentstherequirementsperkghavetobegivenseparatelyforthetwosexes,becauseof
differencesinthetimingofthegrowthspurt.Inyoungerchildrenthereislittledifferencefromtheearlierfigures,althoughthewaysin
whichthevalueshavebeenderivedaredifferent.From6yearsonwardsthepresentestimatesaresomewhathigherthantheearlier
ones.Thisreflectsthehighercurrentestimateforadults,sincethemaintenancerequirementhasbeencalculatedbylinearinterpolation
betweeninfantsandadults.Muchofthedifferencedisappearswhenrevisedcorrectionsaremadeforproteinscoreanddigestibility
(section7.3).

Table33.Safelevelofproteinintake(milkoreggprotein)ofinfantsandchildrenupto10yearsofage(sexescombined)
Age
(years)
0.250.5
0.50.75
0.751
11.5
1.52
23
34
45
56
67
78
89
910

Maintenancea

Growthb

Total

+2SDc

CV%

(mgN/kgperday)
120
120
120
119
119
118
117
116
115
114
113
112
111

100
80
64
41
31
28
24
21
17
17
17
17
17

220
200
184
160
150
146
141
137
132
131
130
129
128

297
264
237
202
187
181
175
170
164
163
162
161
155

17.5
16
14.5
13
12.5
12
12
12
12
12
12
12
12

1971
Committeed
(gprotein/kgperday)
1.86

1.65
1.62
1.48
1.44
1.26
1.23
1.17

1.13
1.15
1.09
1.09
1.06
1.03
1.02
1.00
1.01
0.95
1.01
0.90
1.01
0.86
0.99
0.83
Safelevel

aSeetext.
bAftertheadditionof50%totheoreticalincrement,andcorrectionfor70%efficiencyofutilization(seeTable32).
cCVformaintenancetakenas12.5%CVforgrowthtakenas35%.CombinedCV(CV )calculatedas:
total

dReference(1a).

Table34.Safelevelofproteinintakeforadolescentgirlsandboys(1018years)
Age
(years)
Girls
1011
1112
1213
1314
1415
1516
1617
1718
Boys
1011
1112
1213
1314
1415
1516
1617
1718

Maintenance

Growth

Total

+2SD

Safelevel

(mgN/kgperday)

110
109
108
107
106
105
104
103

110
109
108
107
106
105
104
103

19
17
15
13
9
7
2
0

17
17
21
17
17
13
11
7

129
126
123
120
115
112
106
103

127
126
129
124
123
118
115
110

161
157
154
150
144
140
132
129

159
157
161
155
154
147
144
137

(gprotein/kgperday)

1.00
0.98
0.96
0.94
0.90
0.87
0.83
0.80

0.99
0.98
1.00
0.97
0.96
0.92
0.90
0.86

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1971
Committee

0.78
0.75
0.71
0.65
0.60
0.58
0.57

0.82
0.80
0.78
0.75
0.70
0.65
0.63

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CalculationsandnotesasforTable33.
ThegrowthcomponentinTable32hasbeenderivedfromtheoreticalvaluesforNincrement,whereasnearlyallbalancestudiesin
childrenonusualintakes,manyofwhichwerewellabovetherequirement,haveshownthattheyretainmorethanthetheoretical
amountsofN(8284).Althoughthesestudiesdifferintypeofsubjectandamountandkindofprotein,theyagreeinshowingapparent
Nbalancesgreaterthanthoseexpectedfrommeasurementsofbodycompositioninmanorcarcassnitrogeninanimalexperiments.
ThediscrepanciesbetweenobservedandexpectedbalancearesmallestwhenNretentionishigh,suchasininfantsandalsoin
childrenduringcatchupgrowth(75).Theyarelargestwhenintakesarehighandretentionisexpectedtobelow,suchasinolder
childrenduringnormalgrowth.Thissuggestsaninherentproblemofmethodology.ItiswellknownthattheerrorsoftheNbalance
methodsummatetoexaggeratetheapparentretention(85).1
1AnalternativeapproachexaminedbytheConsultationwastoestimatetheproteinrequirementfromthebasalmetabolicrateaprocedureanalogousinprincipletotheusebythe
1971Committeeofthefactor2mgNperbasalkcaltoestimatethemaintenancerequirement.Sincereliableestimatesofthemaintenancerequirementhavenowbeenobtainedfrom
Nbalancemeasurements,calculationfromtheBMRwouldonlybeusefultoprovidevaluesforthetotalrequirement.However,theBMRperkgchangeslittlebetween6monthsof
ageand3years(Table5),whereasthegrowthraterapidlyfallsoff.ThuschangesinBMRwithageinnowayreflectthechangesingrowthrate,andhenceinproteinrequirement,
thatoccurininfancyandtoalesserextentinpuberty.Thisapproach,therefore,cannotbeconsidereduseful.

Longertermbalances.Asemphasizedearlier(section5),althoughshorttermNbalancestudiesprovidevaluableinformation,the
conditionsareartificialandtheconclusionsdrawndependheavilyonaseriesoflargelyunverifiedassumptions.Longtermstudies
duringwhichchildrengrownormallywouldclearlyinspiremuchgreaterconfidenceregardingtheadequacyofthedietsfed.Detailsof
thefewavailablelongtermbalancesatasinglelevelofproteinintakeareshowninTable35.Thedietsfedintheselongtermstudies
werecontrolledatafixedlevelandwerecomposedoffoodscommonlyeatenbypoorpeopleinthecountriesrepresented.Allexcept
theoldestgroupwerepoorchildrenandmosthadaprevioushistoryofmalnutritionandstunting.Somewereparasitizedandallhad
minorfebrileandafebrileillnessesduringthestudies.Theweightgainwasingeneralsatisfactory,butsomechildrendidnotgainweight
attheexpectedratesatsomeperiods.Itisthereforequestionablewhetherthedietsfedshouldbethoughtofasmeetingaverage
requirementsorconstitutingasafelevelforgroupsofchildrengrowingatindividuallyvariablerates,includingshortintervalsoflittleor
nogain.
Interpretationofthelongtermbalancefiguresisdifficultinviewofthedifferentagerangescoveredbythevariousstudies.
Inthelongtermbalancestudyonchildrenaged812months(Table35,studyA)anintakeof1.35gofproteinperkgperday(after
correctiontothedigestibilityofcow'smilk)supportedsatisfactorygrowthinalmostallofthechildrenformostofthetime,butnotinall
thechildrenatalltimes.Itmay,therefore,bereasonabletoconsiderthisasanaveragerequirementforchildrenatthisageunderthe
conditionsofthestudy.Thisvalueis8%higherthantheaveragerequirementof1.25gperkgperdayat69monthsderivedbythe
factorialmethod(Table32).Additionof2SD(CV12.5%)wouldgiveasafelevelof1.75gofproteinperkgperday.Thismaybe
regardedasarealisticestimateofthesafelevelofproteinintakeforchildrenof69monthsinadevelopingcountrywherethechildis
exposedtoinfectionsandperhapsperiodicshortagesoffood.Undertheseconditions,itmaybewisetoadoptanestimateofthesafe
levelofproteinintakethathasbeenderivedfromstudiescarriedoutinacomparablesituation.Thequestionoftheadditionaldemands
imposedbythesestressesisdiscussedinmoredetailinsection9.

Table35.Resultsoflongtermnitrogenbalancestudiesinchildren

StudyA
(ref.86)

Age(x)

812(10)months 2240(30)months 2946(30)months 25years

No.ofsubjects,sex
Durationofstudy(days)

6M
90

6M
120

Weightgain(g/day)

9.4b

11c

Proteinsource

rice:fish
70:30

StudyB
(ref.87)

StudyC
(ref.83)

StudyE
(ref.88)

StudyF
(ref.88)

20F+M
180

79yearsa
13F
48

6F
42

7.28.2d
82%beans+
95%beans+corn
corn+veg.
5%veg.
18%animal

NA

NA

11M
77

StudyD
(ref.84)

wheatorrice+veg. mixed,45%animal allvegetable

Intake/kgperdayenergy,kcalth|x

8893(90)

8291(86)

7993(85)

100

78

80

energy,kj|x
protein,g

368389(376)
1.76

343380(360)
1.73

331389(356)
1.85

418
2

326
0.80

335
1.39

73
Apparentdigestibility(%)f
Proteinintakecorrected
1.35
todigestibilityofcow'smilk(g/kg)

599

725

66

80

77

1.07

1.40

1.39

0.67

1.14

CrudeNbalanceg
(mg/kgperday)

71100

687

9022

100

25(1343)

28(1342)

aDatafordiets8and1112ofthepublishedstudy(88).
b1childdidnotgainweightatanadequaterate.
c4childrenhadintestinalparasitesandallhadmildupperrespiratorytractinfectionsduringthestudy.Allchildrengainedweightand3showedcatchuplineargrowth.
d4childrenhadfebrileinfectionsduringthestudy,5hadotherafebrileillness,andafewvomitedoccasionally.1childdidnotgainweightand2gainedatlessthantheexpectedrate.5
childrenhadnormallineargrowthand1showedcatchupgrowth.
eChildrendescribedashealthyandgrowingaccordingtoUSstandards.
f
gIntakefaecalNurinaryN.

Inthelongtermstudiesonpreschoolchildrenthedietsfedincludedalargeproportionofplantfood,sothatdigestibilitywasbelowthat
recordedfordietsbasedonmilkandeggs.Oncethefactorofdigestibilityistakenintoaccount,theamountofproteinthatappearsto
supportexpectedgrowthratesof25yearoldchildreninthelongtermstudies(Table35,studiesB,C,andD)doesnotdiffermarkedly
fromtherequirementofhighqualityproteinpredictedfromtheshorttermstudies.Thisobservationindicatesthattheaminoacid
compositionofpracticaldietsisnotnecessarilyalimitingfactorforpreschoolchildrenwhenconsumedintheproportionsusedinthe
longtermstudies.However,thehabitualhomedietsofsomepopulationsmayprovidethesamefoodsindifferentproportions,andtheir
constituentproteinsmaynotsupplyanadequatecombinationofessentialaminoacids.Underthesecircumstancesthepoorprotein
qualitymayrequirehigherintakes.Themarginofsafetyisobviouslylessforchildrenthanforadults,andtherangeofnationaldiets
needstobeexaminedwithrespecttoaminoacidcontentaswellasdigestibility,beforeconcludingthatnofurtheradjustmentforthese
factorsisneeded.Howthisistobedoneisshowninsection7.3.
Longtermbalancestudiesprovidelittleinformationthatmightallowafirmestimatetobemadeofthesafelevelsofintakeofschoolage
childrenandadolescents.Asampleofdatafromstudiesof79yearoldgirlsisincludedinTable35(studiesEandF).
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IntheUnitedStatesofAmericaasinglestudyof1415yearoldboys(89)indicatedthatanintakeof100120mgNperkgperday
fromamixeddietwasneededtoproduceconsistentlypositiveNbalances.Thisrepresentsanaverageintake,notcorrectedfor
digestibility,of0.620.75gofproteinperkgperdayinboystowardstheendofthepubertalgrowthspurt.

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