Validation of energy requirement equations for estimation of breast milk consumption in infants

Abstract

Objective: To test equations for calculating infants' energy requirements as a simple and reliable instrument for estimating the amount of breast milk consumed in epidemiological studies where test-weighing is not possible. Design: Infants' energy requirements were calculated using three different equations based on reference data and compared with actual energy intakes assessed using the 3 d weighed dietary records of breast-fed infants from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. Setting: A sub-sample of 323 infants from the German DONALD Study who were predominantly breast-fed for at least the first four months of life, and who had 3 d weighed dietary records and repeated body weight measurements within the first year of life. Subjects: Healthy, term infants breast-fed for at least 4 months, 0-12 months of age. Results: The overall differences between measured energy intake and calculated energy requirements were quite small, never more than 10 % of total energy intake, and smaller than the mean variance of energy intake between the three days of recording. The equation of best fit incorporated body weight and recent growth, while the worst fit was found for the equation not considering body weight. Conclusions: Breast milk consumption in fully and partially breast-fed infants can be reasonably quantified by calculating the infants' individual energy requirements via simple equations. This provides a feasible approach for estimating infant energy intake in epidemiological studies where test-weighing of breast milk is not possible. Keywords Energy intake Energy requirements Infants Breast milkData on the amount of breast milk consumed by exclusively as well as partially breast-fed infants are mandatory for various epidemiological purposes. For instance, such data are required for evaluating the intake of total energy and specific nutrients in infants (1,2) , for investigating the association between breast milk intake and growth (3,4) and for examining potential factors which influence breast milk consumption (5,6) . Various methods exist to estimate breast milk consumption including measurement of dose-to-the-mother 2 H 2 O turnover (1) , the test-weighing method (3,4) (where the infant is weighed before and after each breast milk feeding for 24 h), assumption of a specific breast milk volume depending on the feeding duration and age of the baby (5,7) , and the assumption of a single volume of breast milk (e.g. 750 ml/d) irrespective of the age of the breast-fed infant (2,8) .Each of these methods has specific advantages and disadvantages (9) . For example, dose-to-the-mother 2 H 2 O turnover and test-weighing are reportedly the most accurate methods (9) but are not feasible in large epidemiological studies due to the high costs, requirement for personnel and logistics involved. On the other hand, less complex and cheaper methods, such as assuming a single volume of breast milk, do not take into account age, sex, weight, growth or the amount of complementary...

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