Pediatric Nutrition in Practice

4 Annexes

Infants and children with growth faltering often
need an enhanced intake of energy and nutrients.
Increasing the energy density, i.e. the amount of
energy per food portion or per millilitre of a liq-
uid food, can increase the total energy intake even
when the total amount of food taken remains lim-
ited. Such an increase in energy density can be
achieved by using one or several elements of a
stepwise approach.

Elements of a Stepwise Approach to Increase
Energy and Nutrient Supply

(1) Analysis of needs, diet and feeding situation
(2) Individual, professional counselling on di-
etary choices and on feeding practice
(3) Offer meals and snacks more frequently, in-
cluding a small late meal before going to bed
(4) Preferential choice of energy-dense foods,
drinks and snacks
(5) Enrichment of formula and home foods
with glucose polymers and/or oils
(6) Use of drinkable supplements (sip feeds)
(7) Tube feeding (nocturnal/continuous)
(8) Parenteral nutrition

Infants: Options for Increasing Energy

Density of Expressed Human Milk or Infant

Formula

Increased Concentration of Infant Formula

The use of 15% powder instead of 13% increases

the energy density by 15%. The concentration

should be increased stepwise according to indi-

vidual tolerance. Concentrations >17% (+30%

energy density) should usually be avoided.

Disadvantage: The increased formula density

increases renal solute load and may reduce toler-

ance.

Addition of Glucose Polymers

Glucose polymers (dextrin maltose or glucose

polymer mixtures) can be added with stepwise in-

creasing concentrations from 1 up to 4 g/100 ml,

which adds ∼ 3.9–15.6 kcal/100 ml milk/formula.

The concentration should be increased stepwise

according to individual tolerance.

Disadvantage: The supply of essential nutri-

ents per kilocalorie is reduced and may not al-

ways be sufficient, particularly for catch-up

growth.

Addition of Glucose Polymer-Fat Mixtures to

Infant Formula

Preparations of glucose polymers with either veg-

etable oil (e.g. soybean oil) or medium chain tri-

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 320–321
DOI: 10.1159/000375193

4.5 Increasing Dietary Energy and Nutrient Supply

Katharina Dokoupil  Berthold Koletzko