Protein and energy requirements in healthy and ill paediatric patients

A reappraisal of available data, together with new studies, suggests that n ormal infants' energy and protein requirements might be substantially lower than previously estimated. For example, the safe level of protein intake w ould amount to only IO g per day during the first 2 years of life and to ab out 12 g per day during the third. This has direct consequences for the man agement of malnourished children, particularly for defining an optimal prot ein:energy ratio. A reduced food intake has long been accepted as the main cause of malnutrition. However, evidence has accumulated suggesting that me tabolic dysregulation may also play a part. This is particularly true for p roteins. Net protein deposition in the growing child results from protein s ynthesis rates being higher than protein breakdown. However, this setting c an be disrupted by a significant increase in protein breakdown in response to cytokines. This mechanism, which is found in acute as well as in chronic inflammatory processes, may lead to severe protein malnutrition and is not always amenable to nutritional support.