Additional fat for breastfed infant

Energy requirement for growth from http://www.unu.edu/Unupress/food2/UID01E/uid01e0d.htm

I might be able to figure out the answer from my question from this article? I hate math. But I think if I can figure out how much additional fat she needs, if I can figure out how much fat is in my breast milk and how much she drinks??? If anyone knows an easier way, please let me know….

Although the energy requirement for growth relative to maintenance is small, except for the first months of life, satisfactory growth is a sensitive indicator of whether needs are being met. To determine the energy cost of growth, the energetics of growth must be understood and satisfactory growth velocities must be defined. The 1985 requirements were based on the growth reference published for international use by WHO (1983), which were derived from the United States National Center for Health Statistics growth curves (NCHS, 1977). What constitutes appropriate infant growth is a topic of controversy and is currently under debate at WHO. Because of policy implications, the findings of the WHO Expert Committee on ‘Physical Status: The Use and Interpretation of Anthropometry During Infancy’ should be considered if the FAO/WHO/UNU Energy and Protein Requirements are revised. Quantitatively, revision of infant growth curves will minimally impact estimated energy requirements. If growth curves were revised to reflect the growth velocities of breast-fed infants, energy requirements would decrease by 10, 16, 24 and 12 kcal/d for 0-3 months, 3-6 months, 6-9 months and 9-12 months, respectively.

In addition to the growth velocity, the energy cost of growth must be known. This cost consists of the energy content of the newly synthesized tissues and the energy expended in synthesis. In the 1985 report the energy cost of weight gain was reviewed in Annex 4 (FAO/ WHO/UNU, 1985) The value proposed for healthy term infants was 5.6 kcal/g gained. We measured the energy cost of growth in term infants and arrived at an estimate, 4.8 kcal/g (Butte et al, 1989). An additional report appeared on the energy cost of growth of infants recovering from malnutrition; the total energy cost of growth was 6-7 kcal/g (Fjeld et al, 1989). The estimated energy cost of growth is more accurate when the separate costs of protein and fat deposition are taken into account, since the components of weight gain change dramatically through the first year of life. However, the practicality of this point is significantly diminished by the fact that the energy cost of growth as a percentage of total energy requirement decreases from 35% at 1 month to 3% at 12 months.

The total energy cost of growth and its components is presented in Table 5 (Figure 4). For the present discussion, the rates of weight gain and components of weight gain, as described by Fomon et al (1982), have been used. For lack of specific information on the composition of weight gain of breast-fed and formula-fed infants, no distinction was made with respect to potential differences in the energy cost of growth between feeding groups. Median NCHS weights were used to standardize the data. The energetic efficiencies of synthesizing protein and fat were taken to be 42% (1 kcal deposited/2.38 kcal used) and 85% (1 kcal deposited/ 1.17 kcal used), respectively (Roberts & Young, 1988). Energy equivalents for fat and protein were 9.25 kcal/g and 5.65 kcal/g, respectively.

Table 5 Energy cost of growth through infancy

^a Monthly rates of weight gain (Fomon et al, 1982).
^b Monthly rates of &t and protein deposition (Fomon et al, 1982).
^c Energy equivalents for fat and protein deposition were taken as 9.25 kcal/g and 5.65 kcal/g, respectively.
^d Energetic efficiencies of synthesizing protein and fat were taken to be 42% (1 kcal deposited/2.38 kcal used) and 85% (1 kcal deposited/1.17 kcal used), respectively (Roberts & Young, 1988).

As calculated, the energy cost of growth displays an abrupt increase at 1-2 months, followed by a gradual decline through 12 months. The abrupt increase in fat deposition may be an artifact due to interpolation of data compiled from different studies by Fomon et al (1982). Unpublished data of Southgate were used to estimate body composition at birth. Body fat was assumed to be linearly related to subscapular and infra-iliac skinfolds between the ages of 3 months and 10 years. A smoothed curve was constructed relating the percentage body fat to age from 1 month to 10 years.

Energy requirements of infants predicted from total energy expenditure and growth

We estimated energy requirements of infants from birth to 12 months of age from total energy expenditure and energy deposition as protein and fat (Table 6, Figures 5 and 6). The energy costs of protein and fat synthesis are covered in the estimate of total energy expenditure and therefore have been excluded from this estimate of energy deposition. The relatively low energy deposition at 0-1 months and high estimate at 1-2 months may be in error. Because fat deposition probably does not increase so abruptly between 1 and 2 months, the average energy deposition for the interval 0-2 months was used in calculating energy requirements. The 1985 FAO/WHO/UNU energy requirements are 9-39% higher than these estimates. These discrepancies are not trivial and could lead to overfeeding of infants.

FIGURE 4 Energy cost of fat and protein deposition in infants (kcal/d).(Boys)

FIGURE 4 Energy cost of fat and protein deposition in infants (kcal/d).(Girls)

A comparison of FAO/WHO/UNU energy requirements and estimations based on energy intakes recorded after 1980 and on TEE and growth is graphically displayed in Figures 7 and 8.

FIGURE 5 Energy requirements of infants estimated from total energy expediture and energy deposition (kcal/d).

Reidun is getting meat with fat and avacado, but I’m not sure how much she should be getting? She is getting 4T of meat a day, 2 of the days the meat is low in fat (turkey and chicken breasts–the only fowl I could find that was free range and organic.) The other two days she is getting veal and lamb. Every 4th day she is getting avocado. She is on a rotation diet. I want to add oils like olive, flaxseed and cod liver, but it is suggested due to her allergies that I wait until she is a year of age. Heidi T.2007-4-13 16:43:32

Yes, avocado oil is a good idea. But I think the day she is eating avocado, she is getting enough fat. I’m not sure about the other three days? Perhaps I’m being too an*l about this rotation diet thing . I can also look harder for dark fowl meal with skins for fat.

But I still haven’t found the answer to how much additonal fat she should be getting a day? I think I can figure it out, I’ll just need to sit down tonight and force myself to do a little math…or I can spend some more times looking for the direct answer in some article somewhere . Thanks again!

Natalia: Reidun is tolerating meat with no problem, and she also likes the taste of it (which I thought was unusual for infants). I am allowing her to have foods based on this table. The meats they recommend for Reidun’s age: turkey, lamb, chicken and veal. http://www.hallpublications.com/title2_sample2.html

I started meat with her when she was about 7 1/2 months, but only in really small amounts, like 1 teaspoon daily. I have really bumped it up recently (to 4 tablespoons daily) due to her lack of weight gain. She has only gained 6oz in the last three months, and has dropped from being in the 75th percentile in weight at birth to the 15th at her 9 month check up.

Heidi T.2007-4-13 17:3:3

Eww…., I should also do some math to make sure the 4T of meat and all the breastmilk she is getting is providing the correct amount of protein. Here is an article “Are There Negative Effects of an Excessive Protein Intake?”

http://pediatrics.aappublications.org/cgi/content/full/106/5 /S2/1293

Naomi: Thank you for the info, I hadn’t heard that before.