Energy balance during recovery from malnutrition

Abstract

This report presents an account of energy balance of young Jamaican children recovering from protein-energy malnutrition (PEM). This was done in three steps. Initially the true gross energy of a formula used in the treatment of PEM was determined by bomb calorimetry. Then its metabolizable energy content was determined in a group of nine children recovering from PEM. In a similar but different group of eight children total daily metabolizable energy intake (EI), average rate of weight gain (g/kg/day) (WG), and total daily energy expenditure (TDEE) were determined. TDEE was determined by indirect calorimetry using a heart rate counter and is based on the relationship of heart rate to oxygen consumption. In this group, the mean EI was 122.5 kcal, WG was 8.4 g, and TDEE was 92 kcal. The difference between EI and TDEE was 30.7 kcal/kg, or 3.3 kcal/g of weight gain. This difference is presumed to be the stored energy in new tissue and corresponds to a proposed new tissue composition of 31% fat and 14% protein. A regression curve comparison of WG versus EI showed that at zero weight gain EI was 85.5 kcal and each additional gain. The difference of 1.0 kcal between total energy cost and stored energy reflects the energy required to deposit new tissue. Gram weight gain required 4.4 kcal. The latter figure is felt to reflect the total energy cost of weight. From three independent measurements, an estimate of maintenance energy requirements was estimated to be about 82 kcal/kg/day.

Body weight gain in free-living Pima Indians: effect of energy intake vs expenditure

“…The positive energy balance necessary to deposit 6 kg of body weight over 4 y can be calculated to be a sustained 30-40 kcal/day excess. [24][25][26] Proviso these calculations are of limited value, since they are nondynamic and do not take into account the fact that the measured positive energy balance is likely to be attenuated over time by the over-compensatory increase in energy expenditure caused by the weight gain. 43,44 We have previously been unable to show a relationship between cTEI and self-reported energy intake.…”

“…8 cTEI, as estimated in this study, depended on accurate measurements of body weight and rested on many metabolic assumptions. [24][25][26] For example, the calculations of the caloric equivalent of changes in body energy stores during the week-long measurement must be interpreted with caution, since we do not have any experimental evidence that all subjects gained or lost the same amount of water and metabolically active tissue. We believe that rigorous validation studies are needed to establish how closely cTEI approximates the true daily energy intake in humans.…”

“…For weight loss, 9 kcal/g FM and 1 kcal/g FFM lost were used. [24][25][26] Thus, the formulas used for calculation of the total energy intake were as follows:…”

Does metabolic compensation explain the majority of less-than-expected weight loss in obese adults during a short-term severe diet and exercise intervention?

“…[28][29][30] The energy equivalence of fat mass (FM) and fat-free mass (FFM) loss was determined from standard caloric equivalents: 9.45 kcal per g FM and 1.13 kcal per g FFM. 31,32 Five different approaches were employed to determine the predicted weight loss:…”

Progress in the Treatment of Protein–Energy Malnutrition

“…Micro-organisms tend to colonize the intestinal tract in PEM and are a potential source of endotoxin production and gram-negative sepsis. It has been suggested that administration of Metronidazole (for anaerobic organisms) and Colistin (for aerobic organisms) reduces the risk of infection and facilitates the regmeration of an intact intestinal mucosa (Suskind, 1975). During the past 18 months, mortality at our Unit in Jamaica has fallen to zero and one of the new measures introduced has been the prophylactic administration of Metronidazole to children who are severely ill. We cannot say whether the association is causal or merely coincidental, but it would appear to merit investigation.…”