The Effect of Intestinal Parasites on the Protein Requirement of Undernourished Children as Determined by the Indicator Amino Acid Oxidation Method.

BACKGROUND

The protein requirement of clinically normal but chronically undernourished (stunted) children is unknown. Stressors, similar to intestinal parasites, in poor environments may increase this requirement. The current protein requirement, which is based on factorial methods in healthy, well-nourished children, may be incorrect.

OBJECTIVES

This study aimed to determine the effect of intestinal parasites on the protein requirement of chronically undernourished school-age South Indian children, by the indicator amino acid oxidation technique.

METHODS

Eighteen undernourished school-age South Indian children (aged 6-11 y) were studied before and after treatment for the confirmed presence of intestinal parasites. They were randomly assigned to receive a low or high protein intake from a range of 8 protein concentrations (0.24-2.38 g/kg/d), provided as an egg protein-based amino acid mixture in an isocaloric experimental diet providing energy at 1.7 times the measured resting energy expenditure. A constant and generous intake of the indicator amino acid (phenylalanine and its metabolite tyrosine) was ensured across all intake amounts. A 2-phase linear regression crossover analysis of the pattern of 13C-phenylalanine oxidation across the protein intake amounts before and after treatment identified a minimal oxidation breakpoint that represented the mean protein requirement.

RESULTS

The mean [95% confidence interval (CI)] protein requirement of undernourished school-age South Indian children with intestinal parasites was determined to be 1.25 (95% CI: 1.0, 1.5) g/kg/d. After antiparasite treatment, the requirement was not different at 1.43 (95% CI: 1.1, 1.8) g/kg/d.

CONCLUSIONS

The presence of intestinal parasites does not increase the protein requirement of undernourished Indian children. However, the current mean [+2 standard deviation (SD)] protein requirement of 0.76 (SD: 0.95) g/kg/d might be inadequate for this group.