Birth weight for gestational age, recovery of growth and anthropometric profile of pre-school children born full term: a follow-up study.

INTRODUCTION: Being born small for gestational age (SGA) implies an increase in the childhood morbidity and mortality rates, in addition to being related to changes in the pattern of growth and body composition, which may be associated with the development of risk factors linked to metabolic diseases. Aim of the study: To describe the development of anthropomorphic indicators of children born at full term, small (SGA) or appropriate for gestational age (AGA), up to the sixth month of life, and again when they reached school-age. MATERIAL AND METHODS: This was a prospective cohort study, with 31 children (19 SGA, and 12 AGA), recruited in public maternity hospitals. Subsequently they were attended at an outpatient clinic on a monthly basis, by a multidisciplinary team in the first year of life. These children were re-evaluated when they reached school-age. RESULTS: Both groups showed high percentages of exclusive breastfeeding in the first months of life. Group SGA showed intense early recovery of the growth indicators, characterizing recovery of growth in the first 6 months of life. However, at school-age, they were still smaller, lighter, with a lower quantity of body fat and muscle mass than those born AGA. There was predominance of appropriate anthropometric growth and body composition indicators at school-age, even in Group SGA. Conclusion: At school-age, the children of this study showed no major alterations related to anthropometry.

Fatores associados ao recém-nascido pequeno para a idade gestacional: uma revisão / Newborn risk factors according to gestational age: a review

OBJECTIVE: To discuss the newborns risk factors according to the gestational age emphasizing the maternal and prenatal characteristics. Data Source: We conducted a critical literature review using Medline, Lilacs, Scielo and national and international health committee; the articles were published between 1992 and 2012. The following descriptors were used as search criteria: risk factors, low birth weight, maternal age, and prenatal care. We included publications in Portuguese and English with primary data performed in patients hospitalized or treated in outpatient clinics. The literature search, according to the established strategy, resulted in 50 articles, 10 in MEDLINE, 10 in Lilacs and 30 in Scielo base. However, some were excluded: repeated studies in different databases (08) and those not found in its entirety (05). In Total, 37 articles, 03 textbooks, 01 dissertation and 10 publications were selected by the national and international health committee for this review. Data Synthesis: The influence of risk factors on newborns mortality such as low birth weight and the presence of complications during pregnancy and childbirth, is widely described in the literature. However, there is a complex network involving these factors, combining maternal and newborn characteristics. CONCLUSION: The findings of this study indicated as major factors, cesarean delivery, prenatal care frequency, maternal education, maternal age, newborn female gender and newborn black ethnicity

OBJETIVO: Discorrer sobre os fatores associados aos recém-nascidos pequenos para idade gestacional com ênfase nas características maternas e pré-natais. Fonte de Dados: Realizou-se uma revisão crítica da literatura nas bases de dados Medline, Lilacs, Scielo e dos comitês nacionais e internacionais de saúde, cujos artigos foram publicados no período compreendido de 1992 a 2012. Na estratégia de busca foram utilizados os seguintes descritores: fatores de risco, baixo peso ao nascer, idade materna, assistência pré-natal.Foram incluídas publicações em português e em inglês com dados primários realizados em pacientes hospitalizados ou atendidos em ambulatórios. A busca bibliográfica, segundo a estratégia estabelecida, resultou em 50 artigos, sendo 10 na base Medline, 10 na base Lilacs e 30 na base Scielo. No entanto, foram excluídos: os estudos repetidos nas diferentes bases de dados (08) e os que não foram encontrados na íntegra (5). Ao final, foram selecionados 37 artigos para esta revisão, 03 livros didáticos, 01 dissertação de mestrado e 10 publicações oriundas de comitês nacionais e internacionais de saúde. Síntese de Dados: A influência dos fatores de risco sobre a morbimortalidade infantil tais como o baixo peso ao nascer e a presença de intercorrências na gestação e no parto, encontra-se amplamente descrita na literatura. No entanto, há uma rede complexa que envolve esses fatores, articulando características maternas e do recém-nascido. CONCLUSÃO: Os achados deste estudo indicaram como principais fatores de risco o parto cesariano, a frequência de consultas pré-natal, a escolaridade materna, a idade materna, recém-nascido do sexo feminino e a raça negra

Restriction of dairy products; a reality in inflammatory bowel disease patients.

INTRODUCTION: Calcium deficiency is considered a risk factor for the development of osteoporosis in inflammatory bowel disease (IBD) patients. Various dietary restrictions, including milk products are reported by these patients. OBJECTIVE: To evaluate dairy product and dietary calcium intake by IBD patients. METHODS: This cross-sectional study enrolled 65 outpatients with IBD recruited from one reference center for IBD. A semi-structured questionnaire (to collect demographic, socioeconomic and clinical data) and a quantitative food frequency questionnaire were administered. With regard to clinical data, we evaluated the anthropometric nutritional status, the disease classification, the disease activity index and the presence of gastrointestinal symptoms. Self-reported modifications in the use of dairy products were evaluated. RESULTS: The IBD patients' ages ranged from 20-75 years and 67.0% were diagnosed with ulcerative colitis. The majority (64.7%) reported restricting dairy products. The frequency of gastrointestinal symptoms was higher among the Crohn's disease patients who restricted dairy products than among those with no restrictions (100% vs 42.9%; p = 0.013); this result was not observed among the UC (ulcerative colitis) patients. Disease activity was also more frequent in the IBD patients who restricted dairy products than in those with no restrictions (23.8% vs 4.5%; p = 0.031), and among the UC patients, extensive disease was more common in the patients who restricted dairy products than in those with no restrictions (42.9% vs 20.0%; p = 0.03). CONCLUSION: Restricting dairy products is common among IBD patients, possibly due to disease activity, the presence of gastrointestinal symptoms and the extension of the disease.

Introducción: Se considera que la deficiencia de calcio es un factor de riesgo para el desarrollo de osteoporosis en pacientes con enfermedad inflamatoria intestinal (EII). En estos pacientes se han notificado diversas restricciones dietéticas. Objetivo: Evaluar la ingesta de productos lácteos y calcio de la dieta en pacientes con EII. Métodos: En este estudio cruzado se reclutaron 65 pacientes ambulatorios con EII procedentes de un centro de referencia para EII. Se administraron un cuestionario semi-estructurado (que recogía datos demográficos, socio- económicos y clínicos) y un cuestionario de frecuencia de consumo de alimento. Con respecto a los datos clínicos, evaluamos el estado nutricional antropométrico, la clasificación de la enfermedad, el índice de actividad de la enfermedad y la presencia de síntomas gastrointestinales. Se evaluaron las modificaciones auto-notificadas en el uso de los productos lácteos. Resultados: Las edades de los pacientes con EII variaban entre los 20 y 75 años y el 67,0% fueron diagnosticados de colitis ulcerosa. La mayoría (64,7 %) notificaban una restricción de los productos lácteos. La frecuencia de síntomas gastrointestinales fue mayor en los pacientes con enfermedad de Crohn que restringían los productos lácteos que en aquellos que no lo hacían (100% frente a 42,9%; p = 0,013); este resultado no se observó en los pacientes con colitis ulcerosa CU. La actividad de la enfermedad también fue más frecuente en los pacientes con EII que restringían los productos lácteos que en aquellos sin restricción (23,8% frente a 4,5%; p = 0,031) y, en los pacientes con CU, la enfermedad extensa fue más habitual en pacientes que restringían los productos lácteos que en aquellos que no lo hacían (42,9 % frente a 20,0%; p = 0,03). Conclusión: La restricción de productos lácteos es habitual en pacientes con EII, posiblemente debido a la actividad de la enfermedad, la presencia de síntomas gastrointestinales y la extensión de la enfermedad.

Restriction of dairy products; a reality in inflammatory bowel disease patients / Restricción de productos lácteos; una realidad en pacientes con enfermedad inflamatoria intestinal

Introduction: Calcium deficiency is considered a risk factor for the development of osteoporosis in inflammatory bowel disease (IBD) patients. Various dietary restrictions, including milk products are reported by these patients. Objective: To evaluate dairy product and dietary calcium intake by IBD patients. Methods: This cross-sectional study enrolled 65 outpatients with IBD recruited from one reference center for IBD. Asemi-structured questionnaire (to collect demographic, socioeconomic and clinical data) and a quantitative food frequency questionnaire were administered. With regard to clinical data, we evaluated the anthropometric nutritional status, the disease classification, the disease activity index and the presence of gastrointestinal symptoms. Self reported modifications in the use of dairy products were evaluated. Results: The IBD patients’ ages ranged from 20-75years and 67.0% were diagnosed with ulcerative colitis. The majority (64.7%) reported restricting dairy products. The frequency of gastrointestinal symptoms was higher among the Crohn’s disease patients who restricted dairy products than among those with no restrictions (100%vs 42.9%; p = 0.013); this result was not observed among the UC (ulcerative colitis) patients. Disease activity was also more frequent in the IBD patients who restricted dairy products than in those with no restrictions (23.8%vs 4.5%; p = 0.031), and among the UC patients, extensive disease was more common in the patients who restricted dairy products than in those with no restrictions (42.9%vs 20.0%; p = 0.03).Conclusion: Restricting dairy products is common among IBD patients, possibly due to disease activity, the presence of gastrointestinal symptoms and the extension of the disease (AU)

Introducción: Se considera que la deficiencia de calcio es un factor de riesgo para el desarrollo de osteoporosis en pacientes con enfermedad inflamatoria intestinal (EII). En estos pacientes se han notificado diversas restricciones dietéticas. Objetivo: Evaluar la ingesta de productos lácteos y calcio de la dieta en pacientes con EII. Métodos: En este estudio cruzado se reclutaron 65 pacientes ambulatorios con EII procedentes de un centro de referencia para EII. Se administraron un cuestionario semi-estructurado (que recogía datos demográficos, socio-económicos y clínicos) y un cuestionario de frecuencia de consumo de alimento. Con respecto a los datos clínicos, evaluamos el estado nutricional antropométrico, la clasificación de la enfermedad, el índice de actividad de la enfermedad y la presencia de síntomas gastrointestinales. Se evaluaron las modificaciones auto-notificadas en el uso de los productos lácteos. Resultados: Las edades de los pacientes con EII variaban entre los 20 y 75 años y el 67,0% fueron diagnosticados de colitis ulcerosa. La mayoría (64,7 %) notificaban una restricción de los productos lácteos. La frecuencia de síntomas gastrointestinales fue mayor en los pacientes con enfermedad de Crohn que restringían los productos lácteos que en aquellos que no lo hacían (100% frente a 42,9%; p = 0,013); este resultado no se observó en los pacientes con colitis ulcerosa CU. La actividad de la enfermedad también fue más frecuente en los pacientes con EII que restringían los productos lácteos que en aquellos sin restricción (23,8% frente a 4,5%; p = 0,031) y, en los pacientes con CU, la enfermedad extensa fue más habitual en pacientes que restringían los productos lácteos que en aquellos que no lo hacían (42,9 % frente a 20,0%; p = 0,03). Conclusión: La restricción de productos lácteos es habitual en pacientes con EII, posiblemente debido a la actividad de la enfermedad, la presencia de síntomas gastrointestinales y la extensión de la enfermedad (AU)

Comparison of yogurt, soybean, casein, and amino acid-based diets in children with persistent diarrhea.

Although previous studies have shown successful treatment of persistent diarrhea (PD) with the use of yogurt-based diets, some recent ones speculate the need of special formulas for the nutritional management of PD complicated cases. In the present study, we tested the hypothesis that the consumption of 3 lactose-free diets, with different degrees of complexity, is associated with lower stool output and shorter duration of diarrhea when compared with the use of a yogurt-based one on the nutritional management of PD. A total of 154 male infants, aged between 1 and 30 months, with PD and with or without dehydration, were randomly assigned to 1 of 4 treatment groups. Throughout the study, the patients were placed in a metabolic unit; their body weights and intakes of oral rehydration solution, water, and formula diets, in addition to outputs of stool, urine, and vomit, were measured and recorded at 24-hour intervals. Four different diets were used in this study: diet 1, yogurt-based formula; diet 2, soy-based formula; diet 3, hydrolyzed protein-based formula; and diet 4, amino acid-based formula. Throughout the study, only these formula diets were fed to the children. The data showed that children fed the yogurt-based diet (diet 1) or the amino acid-based diet (diet 4) had a significant reduction in stool output and in the duration of diarrhea. The use of an inexpensive and worldwide-available yogurt-based diet is recommended as the first choice for the nutritional management of mild to moderate PD. For the few complicated PD cases, when available, a more complex amino acid-based diet should be reserved for the nutritional management of these unresponsive and severe presentations. Soy-based or casein-based diets do not offer any specific advantage or benefits and do not seem to have a place in the management of PD.

Lack of effect of nucleotide-supplemented infant formula on the management of acute diarrhea in infants.

Nucleotides have been identified as conditionally essential nutrients. As prevention studies, conducted with nucleotide-supplemented formula, have shown statistically significant decrease in the risk of diarrhea, we tested the hypothesis that the consumption of nucleotide-supplemented formula during an acute diarrhea episode is associated with therapeutic effects in the treatment of infants with acute diarrhea and dehydration. A randomized, double-blind, controlled clinical trial was conducted in which patients were randomly assigned to 1 of 2 treatment groups. The "test" group consumed a nucleotide-supplemented infant formula and the "control" group consumed a nonsupplemented formula. Infants were accommodated in a metabolic unit where body weight, and all intakes and outputs were recorded at 24-hour intervals during hospitalization. Laboratory parameters including blood gases and electrolytes were monitored during hospitalization. Eighty-one male infants ranging in age from older than 1 month and younger than 1 year, with acute non-cholera diarrhea and dehydration were studied. Primary outcomes were stool output and duration of diarrhea and did not differ significantly between the groups, with a stool output of 304.2 (SD 254.0) vs 350.3 (SD 269.1) g/kg and a duration of diarrhea of 83.3 (SD 44.5) vs 88.8 (SD 46.6) for the test and control groups, respectively. Anemia was highly prevalent and breast-feeding practice was not frequent in both groups. The average energy intake and weight gain were similar in the 2 groups. This study demonstrated that nucleotide supplementation of infant formula during episodes of acute diarrhea has no therapeutic advantage compared to conventional infant formula.

Controlled, double-blind, randomized clinical trial to evaluate the impact of fruit juice consumption on the evolution of infants with acute diarrhea.

In order to assess the effects of juice feedings during acute diarrhea a double-blind, randomized study was performed in 90 children, mean age of 10 +/- 4.28 months. Thirty patients with acute diarrhea were fed twice-daily 15 ml/kg of Apple Juice (AJ), 30 received White Grape Juice (WGJ), and 30 were given colored and flavored water (WA) as part of their age appropriate dietary intake. The duration and severity of diarrhea were the main endpoint variables of the study performed in a metabolic unit. The patients were similar among the 3 groups, had diarrhea for 50-64 hours prior to admission, and were dehydrated when admitted to the unit for study. Half of the patients in each group were well nourished and the others had mild to moderate degrees of malnutrition. Rotavirus infection was the agent causing the illness in 63% of the patients. The infants fed juice ingested 14-17% more calories than those given WA, (those receiving AJ and WGJ ingested 95 and 98 Calories/Kg/d respectively) whereas those receiving WA consumed 81 cal/kg/d). The increased energy intake was not at the expense of other foods or milk formula. The mean body weight gain was greater among patients receiving WGJ (+ 50.7 gm) as compared with the patients in the AJ group (+ 18.3 gm) or the patients fed WA (- 0.7 gm) (p = 0.08). The duration of the illness was longer in the infants fed juice as compared with those given WA (p = 0.006), the mean +/- SD duration in hours was 49.4 +/- 32.6, 47.5 +/- 38.9 and 26.5 +/- 27.4 in patients fed AJ, WGJ and WA respectively. All patients improved while ingesting juice and none of them developed persistent diarrhea; most recovered within 50 hours of the beginning of treatment and less than one fourth had diarrhea longer than 96 hours in the unit. The fecal losses were also increased among the juice fed patients (p = 0.001); the mean +/- SD fecal excretion in g/kg/h was 3.94 +/- 2.35, 3.59 +/- 2.35, and 2.19 +/- 1.63 in AJ, WGJ and WA respectively. The stool output was highest during the first day of treatment among all the patients, though those fed AJ had the highest volume of fecal losses and those who received WA had the lowest stool excretion. After the first day of treatment the differences in fecal excretion were not significant. The ability to tolerate carbohydrates during the illness and immediately after recovery was similar among the 3 groups of patients. Intake of juices with different fructose/glucose ratios and osmolarities resulted in more fecal losses and more prolonged diarrhea as compared with water feedings, but the patients given juice ingested more calories and gained more weight, particularly among those being fed the juice with equimolar concentrations of fructose and glucose.

Carbohydrate malabsorption may increase daily energy requirements in infants.

OBJECTIVE: Carbohydrate malabsorption in infants has been found to increase nutrient losses. However, the effect of this alteration on daily metabolic rate is unknown. We assessed daily metabolic rates in infants with asymptomatic carbohydrate malabsorption (ACM) after a single fruit juice load. METHODS: Sixteen healthy infants with ACM (63.3 +/- 5.6 cm, 7.5 +/- 1.0 kg, 5.6 +/- 0.8 mo, peak breath hydrogen [BH2] = 39.1 +/- 22.4 ppm) and 16 without ACM (64.3 +/- 3.9 cm, 7.8 +/- 1.0 kg, 5.0 +/- 0.8 mo, BH2 = 9.4 +/- 4.7 ppm), after a single fruit juice load, had 24-h energy expenditure (24-h EE; kcal x kg(-1) x d(-1)), resting (RMR; kcal x kg(-1) x d(-1)) and sleeping (SMR; kcal x kg(-1) x d(-1)) metabolic rates extrapolated from 3.5-h assessments in the Enhanced Metabolic Testing Activity Chamber. Furthermore, RMR was calculated with the World Health Organization (WHO), Schofield weight-based and weight- and height-based equations. Carbohydrate absorption was determined by BH2. Differences (P < 0.05) were determined by t test. RESULTS: All infants with ACM had greater (P < 0.05) extrapolated 24-h EE (91.2 +/- 24.8 versus 78.0 +/- 6.8) and RMR (71.8 +/- 15.2 versus 59.5 +/- 5.9). This represented an increase of 15-18.5%, respectively, in energy expenditures. Carbohydrate malabsorption was a significant determinant of EE, RMR, and SMR. However, the WHO (53.8 +/- 1.0 versus 54.1 +/- 0.9) and both Schofield equations (54.7 +/- 0.9 versus 54.9 +/- 1.0 and 50.6 +/- 7.5 versus 47.3 +/- 6.7) failed to detect any differences in RMR. There was a 20 percentile reduction in growth performance in infants with carbohydrate malabsorption. CONCLUSIONS: Infants with ACM following fruit juice ingestion may have increased daily energy expenditure leading to increased metabolic requirements.

Daily metabolic rate in healthy infants.

BACKGROUND: Previous estimates of daily metabolic rate in infants were based on short-term unstandardized measurements of energy expenditure (EE). OBJECTIVE: Determine 24-hour metabolic profiles in infants. METHODS: Energy expenditure (kcal/min by indirect calorimetry) and physical activity (oscillations in weight/min/kg body weight) were measured in 10 healthy infants (5.0+/-0.8 months, 68+/-3 cm, 7.3+/-0.8 kg) for 24 hours in the Enhanced Metabolic Testing Activity Chamber while allowing parental interaction. Energy intake, 24-hour EE, resting metabolic rate (RMR), and sleeping metabolic rate (SMR) (kcal/kg/day) were determined. In addition, extrapolated 24-hour EE, RMR, and SMR from the first 4 and 6 hours of data were compared with 24-hour measurements. RESULTS: Twenty-four-hour energy intake, EE, RMR, and SMR (mean+/-SD) were 78.2+/-17.6, 74.7+/-3.8, 65.1+/-3.5, and 60.3+/-3.9, respectively. EE and physical activity showed a decrease at 11:30 pm and a return to daytime levels by 5:30 am, suggesting a metabolic circadian rhythm. Extrapolated 24-hour EE, RMR, and SMR from the first 4 hours (72.2+/-6.6, 65.9+/-8.7, and 64.9+/-6.4) and 6 hours (74.8+/-6.7, 65.8+/-6.6, and 64.8+/-5.6) were similar to 24-hour measurements. CONCLUSIONS: An apparent circadian rhythm in metabolic rate and physical activity was detected by 24-hour measurements. Furthermore, shorter-term measurements of the variables were comparable with 24-hour values.

Limitations of probiotic therapy in acute, severe dehydrating diarrhea.

BACKGROUND: Recent studies have shown that probiotics, most commonly, may be useful in treating acute gastroenteritis. However, beneficial effects appear to be limited to a modest decrease in the duration of diarrhea. No studies have evaluated this therapy in moderate to severe dehydrating diarrhea in a metabolic facility. METHODS: Male children less than 2 years of age were admitted to a metabolic unit of the Department of Pediatrics at the Federal University of Bahia, Brazil, with moderate dehydration and were randomized in a double-blind, placebo-controlled fashion. Oral rehydration solution (ORS) was administered per protocol and either placebo or was given in combination with the ORS. Output of urine, stool, and vomitus was recorded along with stool weight, nude body weight, and standard laboratory assessments for hydration. RESULTS: There was no significant reduction in diarrhea duration and stool output in the group. However, Kaplan-Meier survival analysis demonstrated that, even in moderate to severe diarrhea, resolution of the illness occurred so rapidly, that statistically significant benefits of probiotic therapy could not be demonstrated. CONCLUSION: Our data implies that colonization must occur before benefits of probiotics can be realized. Probiotics are, therefore, likely to be of limited benefit in treating diarrheal illnesses of short duration such as viral enteritis. The beneficial effects of probiotics may be limited to prophylactic usage in high-risk populations.

Terapia nutricional enteral na síndrome do intestino curto com fórmula infantil elementar / Enteral nutrition therapy in short bowel syndrome with infantile elemental diet

A Síndrome do Intestino Curto (SIC) se caracteriza por importante estado de má absorçäo de nutrientes, que resulta de uma reduçäo substancial do intestino delgado. Este estudo é um relato de caso de um paciente com SIC, com história de ampla rececçäo intestinal. Paciente do sexo masculino, 23 meses, negro, com desnutriçäo grave, peso de internaçäo 6460 g. Avia de acesso para a nutriçäo foi nasogástrica, sonda de polietileno, infusäo contínua e a dieta utilizada foi uma formula infantil elementar (NEOCATE). A oferta calórica inicial foi de 100 kcal/kg/dia e a propéica foi de 3,0 g/kg/dia, com evoluçäo dependente do ganho ponderal e da readaptaçäo intestinal, alcançando oferta calórica final de 200 kcal/kg/dia e protóica de 6 kcal/kg/dia. O paciente foi mantido em balanço metabólico, com acompanhamento diário de peso, ingestäo e perdas. Cuidados das lesöes infectadas nas ostomias, avaliaçäo nutricional bioquímica, antropométrica e clínica constante foram realizadas. Apesar do paciente ter sido encaminhado inicialmwente para Nutriçäo Parenteral Total (NPT), a via enteral foi utilizada com o uso de uma dieta elementar como última escolha antes da NPT. O paciente foi abordado com sucesso, exclusivamente com nutriçäo enteral. Apresentou curva enteral ascendente, com recuperaçäo do estado geral e nutricional, alcançando no quinquagésimo quarto DHI o peso de 8540 g, que possibilitou um teto cirúrgico necessário para a reconstruçäo do transito intestinal. Apesar do encaminhamento inadequado e do manejo inicial incorreto, o estabelecimento de uma terapia nutricional eficaz foi capaz de proporcionar a sobrevida de um paciente absolutamente viável.(au)

New equations for calculating the components of energy expenditure in infants.

OBJECTIVES: To derive new equations for 24-hour energy expenditure (24-h EE; kcal/d) and resting (RMR; kcal/d) and sleeping metabolic rates (SMR; kcal/d) in young infants by using the Enhanced Metabolic Testing Activity Chamber (EMTAC). METHODS: Data from 50 (25 male/25 female) healthy normally growing infants (4.9 +/- 1.6 months, 7.1 +/- 1.4 kg, 65 +/- 5 cm) who had 24-h EE, RMR, and SMR extrapolated from 4- to 6-hour metabolic measurements in the EMTAC were used to derive new equations for 24-h EE, RMR, and SMR. Equations were derived by means of multiple regression analysis (SPSS 8.0), with weight alone or with length and weight entered as independent variables. Similar data from 10 additional test infants (4 male/6 female, 5.1 +/- 0.6 months, 7.5 +/- 1.0 kg, 65 +/- 5 cm) were used to cross-validate the new equations. RESULTS: Twenty-four-hour EE, RMR, and SMR were 79.6 +/- 19.2, 66.8 +/- 15.1, and 62.3 +/- 10.3 kcal/kg per day, respectively. No differences existed in RMR (kcal/kg per day) from the 10 test infants between the weight (68.6 +/- 1.9) and height-weight based equations (68.4 +/- 6.1) or that measured by the EMTAC (67.6 +/- 10.2). Weight was the major predictor of 24-h EE, RMR, and SMR. The WHO, Schofield-weight and weight-height equations underestimated (P <.05) by 19%, whereas the new equations were within 4% of RMR obtained from the EMTAC. CONCLUSIONS: The new equations for assessing energy requirements in healthy infants are more accurate than those previously published that underestimated 24-h EE by 15 kcal/kg per day.