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Public Health Nutrition. 2005 Oct; 8(7A):940-952.In anticipation of the revision of the 1985 Food and Agricultural Organization/World Health Organization/United Nations University (FAO/ WHO/UNU) Expert Consultation Report on 'Energy and Protein Requirements', recent scientific knowledge on the principles underlying the estimation of energy requirement is reviewed. This paper carries out a historical review of the scientific rationale adopted by previous FAO/WHO technical reports on energy requirement, discusses the concepts used in assessing basal metabolic rate (BMR), energy expenditure, physical activity level (PAL), and examines current controversial areas. Recommendations and areas of future research are presented. The database of the BMR predictive equations developed by the 1985 FAO/WHO/UNU Expert Consultation Report on Energy and Protein Requirements needs updating and expansion, applying strict and transparent selection criteria. The existence of an ethnic/tropical factor capable of affecting BMR is not supported by the available evidence. The factorial approach for the calculation of energy requirement, as set out in the 1985 report, should be retained. The estimate should have a normative rather than a prescriptive nature, except for the allowance provided for extra physical activity for sedentary populations, and for the prevention of non-communicable chronic diseases. The estimate of energy requirement of children below the age of 10 years should be made on the basis of energy expenditure rather than energy intake. The evidence of the existence of an ethnic/tropical factor is conflicting and no plausible mechanism has as yet been put forward. (author's)
Public Health Nutrition. 2005 Oct; 8(7A):932-939.This background paper considers the extent to which the development of new recommendations for dietary energy requirements needs to account for the macronutrient (fat, carbohydrate, protein and alcohol) profiles of different diets. The issues are discussed from the dual perspectives of avoiding under-nutrition and obesity. It is shown that, in practice, human metabolic processes can adapt to a wide range of fuel supply by altering fuel selection. It is concluded that, at the metabolic level, only diets with the most extreme macronutrient composition would have any consequences by exceeding the natural ability to modify fuel selection. However, diets of different macronutrient composition and energy density can have profound implications for innate appetite regulation and hence overall energy consumption. (author's)
Washington, D.C., AED, FANTA, 2004 Jan 8.  p. (USAID Cooperative Agreement No. HRN-A-00-98-00046-00)The nutrient requirements for people living with HIV/AIDS differ from those for non-HIV-infected individuals. These recommendations are based on the report of the May 2003 WHO technical consultation on nutrient requirements for people living with HIV/AIDS. Current evidence suggests that as the HIV infection progresses, the nutrient requirements change. The requirements are different for the two distinct phases of HIV infection, which are characterized by the absence or presence of illness symptoms: asymptomatic and symptomatic. (excerpt)
Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial. [Comparaison de l'efficacité d'une nourriture solide prête à l'emploi et d'un régime liquide à base de lait, en vue du rétablissement d'enfants souffrant de malnutrition grave : un essai randomisé]
American Journal of Clinical Nutrition. 2003 Aug; 78(2):302-307.Background: The World Health Organization recommends a liquid, milk-based diet (F100) during the rehabilitation phase of the treatment of severe malnutrition. A dry, solid, ready-to-use food (RTUF) that can be eaten without adding water has been proposed to eliminate the risk of bacterial contamination from added water. The efficacies of RTUF and F100 have not been compared. Objective: The objective was to compare the efficacy of RTUF and F100 in promoting weight gain in malnourished children. Design: In an open-labeled, randomized trial, 70 severely malnourished Senegalese children aged 6–36 mo were randomly allocated to receive 3 meals containing either F100 (n = 35) or RTUF (n = 35) in addition to the local diet. The data from 30 children in each group were analyzed. Results: The mean (± SD) daily energy intake in the RTUF group was 808 ± 280 (95% CI: 703.8, 912.9) kJ·kg body wt-1·d-1, and that in the F100 group was 573 ± 201 (95% CI: 497.9, 648.7) kJ·kg body wt-1·d-1 (P < 0.001). The average weight gains in the RTUF and F100 groups were 15.6 (95% CI: 13.4, 17.8) and 10.1 (95% CI: 8.7, 11.4) g·kg body wt-1·d-1, respectively (P < 0.001). The difference in weight gain was greater in the most wasted children (P < 0.05). The average duration of rehabilitation was 17.3 (95% CI: 15.6, 19.0) d in the F100 group and was 13.4 (95% CI: 12.1, 14.7) d in the RTUF group (P < 0.001). Conclusions: This study indicated that RTUF can be used efficiently for the rehabilitation of severely malnourished children. (author's)
Nutritional status of vegetarian and omnivorous adolescent girls. [Estado nutricional de adolescentes vegetarianas y omnívoras]
Nutrition Research. 2001 May; 21(5):689-702.This study compared the dietary and anthropometric profile of 24 ovo-lacto-vegetarian and 36 omnivorous female adolescents, between 15 and 18 years old. Weight, height and skinfolds were measured. Food frequency questionnaires and a three day food record were used for dietary assessment. Vegetarians presented subscapular, suprailiac and midaxillary skinfolds statistically higher than omnivores, but the percent body fat was not different. The vegetarian diet provided smaller amounts of energy than that of the omnivores ( p < 0.05) and only 17% of the vegetarians was able to reach the recommended allowance for protein. Regarding calcium, 83% of the vegetarians and 69% of the omnivores ate less than 2/3 of the recommended allowances and a significantly higher percentage of vegetarians presented low ingestion of iron, riboflavin, and niacin than omnivores ( p < 0.05). It was concluded that the intake of vegetarians was lower in fat and cholesterol, and less adequate in micronutrients than the omnivores ones. (author's)
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1985; (724):1-206.In 1981, participants in the Joint FAO/WHO/UNU Expert Consultation on Energy and Protein Requirements met in Italy to reexamine the interrelationships between energy and protein requirements and to recommend methods to integrate requirement scales for energy and proteins. They stated that the use of a reference man or woman to determine energy requirements should no longer be used since it is unduly restrictive and there is a wide range of body size and patterns of physical activity. The tables exhibit this wide range so users can use those values that best apply to his or her conditions. Overall the participants agreed that estimates of energy requirements should be based on actual or desirable energy requirement estimates. In terms of children, however, this principle cannot be applied since there is not enough information available about their energy expenditure. Further no one could agree on how to determine what actual intakes are needed to maintain health in its broadest sense in either developing or developed countries since observed actual intakes are not necessarily those that maintain a desirable body weight or optimal levels of physical activity. Divers patterns of physical activity in different age and sex groups are presented nonetheless to guide users in applying requirement estimates. The maintenance protein requirements identified by the 1971 consultation for the young child < 6 years old, e.g. 1 g/kg.day for 5-6 year old, and the young male adult (.54-.99 g.kg/day) remained the same. The participants made indirect estimates of protein needs for the remaining age and sex groups. They acknowledged that digestibility can affect the availability of protein and protein requirements need to be adjusted for fecal losses of nitrogen. They concluded that the natural diets for infants and preschool children contain sufficient amount of essential amino acids, but not those of the remaining groups.
Hunger and malnutrition: the determinant of development: the case for Africa and its food and nutrition workers.
East African Medical Journal. 1992 Aug; 69(8):424-7.Hunger and malnutrition in Africa have been on the increase since the 1960s. During the 1970s, it is estimated that 30 million people were directly affected by famine and malnutrition. About 5 million children died in 1984 alone. In Mozambique during the 1983-84 famine, about 100,000 people perished. In Ethiopia, Sudan, Somalia, Liberia, and Angola armed conflicts compound the problem. Ethiopia alone had 9 million famine victims in 1983. The most common form of malnutrition in Africa is protein energy deficiency affecting over 100 million people, especially 30-50 million children under 5 years of age. Almost another 200 million are at risk. Iron deficiency, commonly called anemia, also affects 150 million people, mostly women and children. Iodine deficiency leads to disorders like mental retardation, cretinism, deafness, abortion, low resistance to disease, and goiter and this affects 60 million with about 150 million more at risk. Vitamin A deficiency causes blindness and low resistance to disease and affects about 10 million. Protein energy deficiency is treated by using donated foods in hospitals, rehabilitation centers, day care centers, and feeding centers. There are no community programs for anemia, or vitamin A or iodine deficiencies. Vaccines for preventing and drugs for treating diseases that cause malnutrition are imported. Therefore, African food and nutrition professionals met in 1988 and created the Africa Council for Food and Nutrition Sciences (AFRONUS) to eliminate famine and malnutrition in Africa. Activities have started in: 1) developing contacts between the workers in food and nutrition; 2) assessing the situation of food and nutrition in Africa; 3) developing an action plan; 4) implementing the plan; and 5) monitoring progress. Food and Nutrition Policy Guidelines have also been prepared by AFRONUS for food and nutrition workers. Africa has enough natural resources to solve the problem of hunger and malnutrition, but these resources have to be harnessed.
Geneva, Switzerland, World Health Organization [WHO], Division of Family Health, Maternal Health and Safe Motherhood Programme, 1992. iii, 46 p. (WHO/MCH/MSM/92.3)WHO's Maternal Health and Safe Motherhood Programme has guidelines for health workers to detect early signs and symptoms of preeclampsia and to provide early treatment of mild preeclampsia to prevent severe preeclampsia. Health workers must take accurate blood pressure measurements, test for protein in urine, and identify substantial edema. This manual helps them determine when blood pressure equipment does not work accurately and know how to fix it. The manual covers all parts of the sphygmomanometer (blood pressure machine): the cuff, rubber bladder, the aneroid sphygmomanometer, stethoscope, and pump and control valve. Health workers should know that certain conditions elevate blood pressure in normal patients. They can alleviate them to obtain accurate blood pressure measurements. These conditions are fear, cold, full urinary bladder, exercise, tight clothes around the arm, obesity, standing up, and lying on the back. Health workers should place either the left or right arm on a table or on another object thereby allowing the muscles to relax. The upper arm needs to be at the same level of the heart. It is important that all levels of health workers be adequately trained in taking blood pressures correctly. Training should not occur in busy and noisy clinics. The trainer should use a double stethoscope to determine whether the trainees correctly identify the Korotkoff sounds. Health workers must feel pregnant women how to collect a midstream urine sample, free of vaginal secretions and discharges, so the health workers can test for protein in the urine. Its presence indicates kidney failure. Diagnosis of mild preeclampsia includes a blood pressure at least 140/90 mmHg or an increase of 30 mmHg systolic or 15 mmHg diastolic and at least 300 g/l protein in urine. In addition to these signs, sudden onset of edema of face and/or hands, severe headaches, great reduction of urine output, epigastric pain, visual disturbances, and reduced fetal movement are reliable signs of severe preeclampsia.
Rome, Italy, FAO, 1973. 118 p. (FAO Nutrition Meetings Report Series No. 52; WHO Technical Report Series No. 522)The present Joint Food and Agriculture Organization/World Health Organization (FAO/WHO) Ad Hoc Expert Committee met from March 22 to April 2, 1971 to consider energy and protein requirements together and to examine fully this interrelationships so that a diet or a food supply might be assessed simultaneously in terms of its energy and protein content. Its specific tasks were to: examine the characteristics and criteria of the reference man and reference woman; review new data as a basis for revising estimates of requirements and recommended intakes for energy, protein, and essential amino acids; and consider the method of chemical scoring and other methods used in the evaluation of the nutritive value of proteins. The committee was asked to examine the interrelationships between requirements for energy and proteins and to recommend means for the integration of requirement scales for energy and proteins, if that were feasible. Additionally, this committee report includes a discussion of basic concepts, a glossary of terms and units, some background information, as well as identification of practical applications and future research needs. 5 annexes contain: percentiles for weight and height of males and females aged 0-18 years; calculation of the energy values of foods or food groups by the Atwater system; conversion of nitrogen to protein; standard basal metabolic rates of individuals of both sexes; and some values of energy expenditures in everyday activities.