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ARS Home » Plains Area » Houston, Texas » Children's Nutrition Research Center » Research » Publications at this Location » Publication #307541

Title: Revision of dietary reference intakes for energy in preschool-age children

Author
item BUTTE, NANCY - Children'S Nutrition Research Center (CNRC)
item WONG, WILLIAM - Children'S Nutrition Research Center (CNRC)
item WILSON, THERESA - Children'S Nutrition Research Center (CNRC)
item ADOLPH, ANNE - Children'S Nutrition Research Center (CNRC)
item PUYAU, MAURICE - Children'S Nutrition Research Center (CNRC)
item ZAKERI, ISSA - Drexel University

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/15/2014
Publication Date: 5/7/2014
Citation: Butte, N.F., Wong, W.W., Wilson, T.A., Adolph, A.L., Puyau, M.R., Zakeri, I.F. 2014. Revision of dietary reference intakes for energy in preschool-age children. American Journal of Clinical Nutrition. 100:161-167.

Interpretive Summary: US Dietary Reference Intakes (DRI) for energy intake for children are based on the total energy expenditure (TEE) measured by using the doubly labeled water (DLW) method and energy cost of growth. The DRI database was limited in the number of preschool-aged children, 3-5-y-old, who were included. The aim of this study was to generate additional DLW data and reevaluate the DRI for energy for preschool-age children. We enrolled 97 healthy, normal-weight, preschool-age children into a 7-day study that included the DLW method for the measurement of TEE and wearing an activity monitor and a heart monitor. Physical activity level (PAL) is estimated from the ratio of TEE over basal metabolic rate. We found that TEE and PAL averaged 1159 kilocalories per day and 1.71. We evaluated the observed TEE against TEE predicted by DRI equations based on age, weight and height and PAL category. If the sedentary PAL category was assumed, TEE predicted by DRI equations agreed with observed TEE (3%) but was overestimated by using the low active (19%), active (34%), and very active (51%) PAL categories. We found that the DRI PAL categories were not appropriate for preschoolers. We therefore developed new equations to predict TEE from age, weight, height, and new PAL categories. Since current DRIs can substantially overestimate energy requirements of preschool-age children, we recommend the new TEE prediction equations with age-appropriate PAL categories for preschool-age children.

Technical Abstract: Dietary Reference Intakes (DRI) for energy aim to balance energy expenditure at a level of physical activity consistent with health and support adequate growth in children. DRIs were derived from total energy expenditure (TEE) measured by using the doubly labeled water (DLW) method; however, the database was limited in the 3-5-y-old range.OBJECTIVE: We reexamined the DRI for energy for preschool-age children.DESIGN: Ninety-seven healthy, normal-weight, preschool-age children (mean ± SD age: 4.5 ± 0.9 y) completed a 7-d DLW protocol while wearing accelerometer and heart rate-monitoring devices.RESULTS: Mean TEE and physical activity level (PAL) averaged 1159 ± 171 kcal/d and 1.34 ± 0.14, respectively. TEE predicted by DRI equations agreed with observed TEE (+34 kcal/d or 3%) if the sedentary PAL category was assumed but was overestimated by using the low active (+219 kcal/d or 19%), active (398 kcal/d or 34%), and very active (593 kcal/d or 51%) PAL categories. PAL categories were redefined on the basis of the narrower PAL range observed in preschoolers (range: 1.05-1.70) compared with older children and adults (range: 1.0-2.5). Sex-specific nonlinear regression models were newly developed to predict TEE from age, weight, height, and new PAL categories. The mean absolute error of TEE prediction equations was 0.00 ± 35 kcal/d or 0.1 ± 3%. Ancillary measures, such as total accelerometer counts and total daily steps, that were significantly correlated (P = 0.01-0.05) with TEE (r = 0.26-0.38), TEE per kilogram (r = 0.31-0.41), and PAL (r = 0.36-0.48) may assist in the classification of preschoolers into PAL categories.Conclusions: Current DRIs for energy overestimate energy requirements of preschool-age children because of the erroneous classification of children into PAL categories. New TEE prediction equations that are based on DLW and appropriate PAL categories are recommended for preschool-age children. This trial was registered at clinicaltrials.gov as H12067.