Objective. To evaluate the adequacy of protein intakes now recommended as safe for infants and toddlers.Methods. Subjects were recovering malnourished infants, age 5.3 to 17.9 months, length age (LA) 2.5 to 6.4 months, weight age (WA) 1.5 to 5.2 months, weight/ length (W/L) 78% to 100% of National Center for Health Statistics data; and toddlers age 11.4 to 31.6 months, LA 6.1 to 17.9 months, WA 3.9 to 12.0 months, W/L 79% to 99%. Infants were assigned at random to formulas with 5.5% 6.7%, or 8.0% energy as 60:40 whey:casein protein. The 5.5% was based on FAO-WHO-UNU safe protein and average energy for ages 2.5 to 6.0 months. Toddlers received 4.7% (recommended for 6 to 18 months), 6.4%, or 8.0%. Identical concentrations (weight/kcal) of other nutrients were maintained; intakes were adjusted weekly to reach, in 90 days, the 50th percentile of weight for a LA 3 months greater than the initial one.Results. Infants consumed 125 +/- 11 (SD), 116 +/- 10, and 126 +/- 14 kcal and 1.7 +/- 0.1, 1.9 +/- 0.2, and 2.5 +/- 0.3 g protein kg(-1) d(-1); gained 2.4 +/- 0.7, 2.9 +/- 0.7, and 2.6 +/- 0.5 months in LA, and reached a W/L of 105 +/- 5, 103 +/- 6, and 105 +/- 5% of reference. Sum of four fat-folds (Sigma, FF) grew 13.1 +/- 6.9, 10.4 +/- 4.8, and 11.7 +/- 5.3 mm to 325 +/- 5.2, 31.7 +/- 4.7, and 30.5 +/- 5.5 mm; arm muscle areas (AMA) 57%, 51%, 70% to 1004 +/- 109, 1017 +/- 110, and 1004 +/- 116 mm(2), still low; arm fat areas (AFA) 93%, 66%, and 93% to higher-than-normal 598 +/- 105, 610 +/- 101, and 541 +/- 116 mm(2). Regression of intake on weight gain estimated energy for maintenance + activity to be 81.0 +/- 7.5 (SEM) kcal . kg(-1). d(-1), and cost of gain (storage + metabolic cost) as 7.6 +/- 1.7 kcal/g, with no significant effect of % protein.Toddlers consumed 107 +/- 9, 103 +/- 12, and 105 +/- 10 kcal and 1.3 +/- 0.1, 1.6 +/- 0.2, and 2.1 +/- 0.2 g protein . kg(-1). d(-1); gained 3.3 +/- 0.7, 2.9 +/- 0.6, and 3.3 +/- 0.7 months in LA; to a W/L of 102 +/-, 102 +/- 3, and 101 +/- 4%. Sigma FF grew 9.2 +/- 4.0, 7.4 +/- 4.3, and 6.0 +/- 3.8 to 28.9 +/- 5.2, 30.5 +/- 3.7, and 27.0 +/- 2.7 mm; AMA 31%, 33%, and 34% to 1121 +/- 115, 1124 +/- 110, and 1117 +/- 120 mm(2); AFA 53%, 44%, and 45% to higher-than-normal 578 +/- 106, 636 +/- 99, and 569 +/- 68 mm(2). Cost of maintenance + activity was 70.8 +/- 3.8 (SEM) kcal . kg(-1). d(-1), that of weight gain 9.7 +/- 1.35 kcal/g, with no effect of % protein.Conclusions. Within age groups, there were no significant protein-related differences in growth. In both infants and toddlers, high-energy intakes resulted in mild obesity, with lean body mass still deficient. Protein intakes two SD below the means in the lowest protein/energy cells, 1.5 g . kg(-1). d(-1) for infants and 1.1 g . kg(-1). d(-1) for toddlers, should still be safe for nearly all children of comparable biological ages.

Post-prandial (p.p.) changes in plasma free amino acid (AA) concentrations of children consuming a single source of protein at critical levels are determined by its digestibility and total essential AA/total AA ratios; the molar proportion of the limiting EAA (EAA/TEAA), if any, will fall significantly in plasma as it is utilized more completely than others. Grain amaranths (Am), reputedly rich in lysine (Lys) and tryptophan (Trp), but moderately deficient in leucine (Leu), should be ideal complements to Lys and Trp-poor, Leu-rich maize (M). Most animal studies confirm this. In children, 20, 30 and even 50 per cent replacement of M proteins with toasted Am proteins had failed to show any gains over M or Am alone: heat losses of Lys were suspected. Plasma obtained during the above studies, before and 3 h and 4 h after the first meal of the last day of consuming Am alone, three M-toasted Am mixtures, or M alone, were analysed for free AAs. Toasted, popped or flaked Am consumption caused significant p.p. falls in molar proportions of Leu from 99 to 85, 88 to 82, and 92 to 75, and of threonine (Thr) from 118 to 108 (popped) and 109 to 97 (flaked) mmol/mol TEAA, suggesting that these were first- and second-limiting EAAs. Post-prandial fall in Lys proportion was questionably significant. The M diet produced highly significant 3-h Leu elevation from 132 to 187, Lys fall from 167 to 135, and Trp fall from 62 to 46 mmol/mol TEAA.(ABSTRACT TRUNCATED AT 250 WORDS)

Earlier studies demonstrated that quality protein maize (QPM), with increased lysine and tryptophan and decreased leucine contents, was more digestible and supported 45% greater nitrogen retention than common maize. Ten recovering malnourished children (ages 13 to 29 months, height-ages 5 to 15 months, weight-ages 3 to 11 months) have now received 90% of their diet energy and 100% of protein and fat from QPM. Energy intake was adjusted to allow them to reach the 50th centile of weight-for-length (according to the National Center for Health Statistics) in 90 days (two completed 60 days only). Growth was compared with that of 10 children receiving modified cow's milk formula (CMF). Energy intakes (QPM 110 +/- 15, CMF 106 +/- 12, corrected for absorption to 94 and 97 kcal/kg.d), crude energy costs of gain (43 +/- 9 and 40 +/- 10, corrected to 37 and 37 kcal/g), linear growth (1.23 +/- 0.24 and 1.33 +/- 0.26 cm/mo), gains in height-age (3.1 +/- 0.7 and 3.3 +/- 1.2 mo), weight gain (2.6 +/- 0.6 and 2.6 +/- 0.8 g/kg.d), and final sums of fat folds (24.3 +/- 3.5 and 27.2 +/- 2.9 mm) were not different. Gains in weight-age were greater (7.5 +/- 2.3 vs 5.4 +/- 1.6 months, P less than .05) and serum albumin decreased (4.10 +/- 0.24 to 3.77 +/- 0.31 g/dL, P less than .01) during QPM feeding. Plasma-free total essential amino acids and ratio of these to total essential amino acids were less after QPM than after CMF diets. Equal growth rates with QPM and CMF diets offer great potential for developing- and developed-country children.

Clinical data from 133 male patients between 3 and 36 months of age were reviewed to identify factors that could predict high rates of fecal excretion during acute diarrhea. Diarrheal severity after hospitalization was measured by separate 4‐h quantitative collections of feces during 6 days; the number of these 4‐h collection periods with any stool output was used as an estimate of the number of bowel movements each day. The number of 4‐h periods with any stool output was highly correlated with total fecal excretion expressed as grams per kilogram of body weight per day (p < 0.001). The age of the patient, type of diarrhea, and type of diet had little effect on the relationship between stool “number” and amount. The number of bowel movements, as estimated during this study, was a highly sensitive (>90%) and reasonably specific (>70%) predictor of children at risk of high fecal excretion rates (>50 g/kg/day or >100 g/kg/day) during acute diarrhea.

The opaque-2 gene was shown years ago to increase the nitrogen, lysine, and tryptophan contents of maize and to markedly increase its nutritional value for small children. Concerns about decreased yield, resistance, and acceptability discouraged further development of the gene. Quality protein maize, while retaining the opaque-2 characteristics, has overcome those constraints. Six recovering malnourished infants received diets in which all of the 6.4% protein energy was supplied by casein, quality protein maize, or common maize. The quality protein maize supplied 60% and common maize 75% of total energy. Vegetable oil was added to increase fat contents to 10% of total energy in all diets. Energy digestibility was less (87% and 84%) from quality protein maize and common maize than from casein diets (94%); most of the difference was due to carbohydrate digestibility. Apparent N absorptions from quality protein maize (70 +/- 5%) and common maize (69% +/- 7%) were much lower (P less than .01) than from casein (82% +/- 4%). Apparent retention of N from quality protein maize (34 +/- 4%) was less (P less than .01) than from casein (41% +/- 9%) but greater (P less than .01) than from common maize (22% +/- 10%). Breath hydrogen excretions were usually greater during quality protein maize consumption than during casein diets but not nearly as much as those during common maize diets. The nutritional advantages of quality protein maize v common maize are of a magnitude that must be exploited for the advantage of children in maize-consuming poor countries.

Amaranthus caudatus L. toasted flour, popped grain and flakes were each fed to nine young children as the source of all diet protein and fat and 50% of diet energy, preceded and followed by casein control diets. All provided 6.4–6.7% of energy as protein and 9.3–10.1% as fat. Balances were carried out during the last 6 d of the three 9-d amaranth periods and during the four control periods. Fecal wet and dry weights during amaranth diets were 129–157% of those during casein control diets; fecal energy, fat and carbohydrate from the toasted flour periods were 193, 268 and 256%; from the popped grain 253, 586 and 195%; and from the flakes 225, 356 and 255% of those during casein diets. Apparent N absorptions were 84.1–84.6% of the casein values (P < 0.001); apparent retentions from toasted, popped and flaked amaranth were 70.9, 65.9 and 59.0% of casein (P < 0.001). The last of these was significantly lower than the first (P < 0.05). Fecal fat was much higher (P < 0.001) from the popped than from the flaked grain and the toasted flour. Toasted flour was then added to maize meal so that amaranth provided 20 or 30% of the protein. Seven young children received diets in which 6.4% of total energy came from one of the above mixes, or from casein, as protein. Soya-cottonseed oils completed 25% lipid energy in all three diets; balance of energy was from sucrose in the experimental diets and from sucrose, corn syrup solids and comstarch in the casein diet. During 9-d periods daily fecal wet weight was 123.4 ± 24.2 g, dry weight 26.6 ± 3.8 g and energy 108. ± 12.3 kcal from the 20% amaranth diet; 113.0 ± 18.2, 25.4 ± 1.9 and 105.8 ± 10.7 from the 30% diet; and 73.6 ± 29.6, 11.9 ± 3.0 and 48.8 ± 12.2 (all P < 0.01) from the casein diet. Fecal fat was very low during all diets; calculated fecal CHO was 16.3 ± 2.6 and 16.3 ± 1.6 g/d for the two maize-amaranth diets, 4.7 ± 2.0 (P < 0.01) for the casein control. Apparent N absorptions (% of intake) were 70.4 ± 4.1, 72.1 ± 5.3 and 83.8 ± 1.9 (P < 0.01) from the three diets; apparent N retentions (% of intake) were 28.0 ± 5.2, 29.0 ± 2.8 and 36.6 ± 3.1 (P < 0.01). With as little as 12.7% by weight (20% of protein) of added amaranth flour, maize meal should be able to satisfy protein and lipid needs of young children if it provides ∼90% of diet energy.

Two varieties of cassava, processed as Nigerian fermented flour (gari) or as Brazilian flour (farinha), were fed to two groups of eight infants and young children, each group receiving both forms of one variety, with preceding, intervening and following casein control diets. The flours provided 50% of diet energy, with casein added to make 8% energy as protein, vegetable oils to make 20% as fat and corn syrup solids and sugar to make 72% carbohydrate (CHO) energy. Fecal wet weight increased (P < 0.05) from approximately 100 g/d (casein diets) to means (± SD) of 202 ± 72, 171 ± 58, 154 ± 46 and 190 ± 67 g/d; dry weights from means of 14.7-18.3 g/d to means of 22.9-24.4 g/d (P < 0.05); fecal energy from means of 50-60 kcal/d to means of 89-94 kcal/d (P < 0.01); fecal fat was generally not affected; and fecal CHO nearly tripled (P < 0.01) from approximately 4 to 12 g/d. Apparent nitrogen absorptions and retentions from the cassava + casein diets were modestly lower than from casein diets. Rates of weight gain were very variable and not significantly different by diet; serum albumin levels were essentially unchanged. The results with these flours were indistinguishable from each other and from those previously found with freeze-dried cassava flour in otherwise identical diets. Variety and processing method had no effect on the digestibility of cassava starch and oligosaccharides and on the great resistance to digestion and the water-holding capacity of cassava fiber.

One hundred twenty-eight nonmalnourished male patients between 3 and 36 months of age were randomly assigned to receive one of four lactose-free dietary treatments to determine the effect of dietary therapy on the severity and nutritional outcome of diarrheal illness. Group 1 received a formula diet composed of casein, sucrose, dextrin with maltose (Dextri-Maltose), and vegetable oil to provide 110 kcal/kg body weight/d (CSO-110). Group 2 received CSO to provide 55 kcal/kg/d (CSO-55) for 2 days and then CSO-110. Group 3 received only oral glucose-electrolyte solution (GES) for 2 days, CSO-55 for the next 2 days, and then CSO-110. Group 4 received the same diets as Group 3 except that only intravenous GES was used for the first 2 days. The GES maintenance solutions provided 24 to 30 kcal/kg/d. Therapeutic success rates were similar among dietary groups, ranging from 90% to 97%. Fecal excretion was initially lower in group 4 (P less than 0.05) but was similar initially among groups treated orally and among all four groups beginning on day 3. Net apparent absorption of nitrogen, fat, carbohydrate, and total energy; retention of nitrogen; and increments in body weight, arm circumference, and skin-fold thickness were positively related to the amounts of dietary energy consumed. Thus continued oral feeding with the CSO diets during the early phase of therapy yielded improved nutritional results.