Infection and catch-up growth

1. Until more data are available, a reasonable estimate of protein needs following infection is a 20-30% increase in total protein (30-50% in the case of diarrhea) during a recovery period that is two to three times longer than the duration of the illness. In the case of persistent diarrhea with accompanying anorexia, the desired increase may be difficult achieve. When children have diarrhea for 20-30% of their time plus other infections, following the above recommendation will essentially result in a permanent increase in the protein level of the diet provided to them until they reach an age when diarrhea is less prevalent.

2. Requirements for children experiencing catch-up growth should consist of a factor for maintenance and a factor for growth. The latter should be determined for various rates of weight gain, as illustrated in Table 21 of the paper by Dewey et al. The values used for maintenance nitrogen needs and the efficiency of conversion from dietary protein to body protein should be consistent with those chosen for normal infants and children.

3. For stunted children of normal weight, protein requirement will be determined by their maintenance needs plus rate of linear growth appropriate for their age and body size. For wasted and stunted children, protein requirement after normal weight-for-height has been achieved will be determined by the weight gain expected at an appropriate rate of linear catch-up growth. Estimates are included in Tables 21 and 22 of the Dewey et al paper. This implies that the P/E ratio increases with the rate of catch-up weight gain.