Pediatric Nutrition in Practice

32 Koletzko

strates and their metabolism differs between in-
fants fed human milk and those fed infant for-
mula and complementary feeds, which can result
in differences in dietary requirements. There-
fore, human milk composition and the nutrient
supply to breastfed infants may not always pro-
vide useful guidance for infants that are not ex-
clusively breastfed.
Due to the paucity of original research data for
estimating nutrient requirements in the paediat-
ric age group, very often NIV are extrapolated
from data for other age groups. Frequently, this
involves extrapolation from adults to children
and adolescents. Examples of extrapolation
methods that are used include body size (weight
or metabolic weight), energy intakes for age, or
factorial estimates of requirements for growth
[8]. However, there is no truly correct method for
extrapolation that would result in physiologically
adequate NIV for infants, children and adoles-
cents. It is important that the rationale or scien-
tific basis for the method chosen should be com-
pletely transparent and thoroughly described for
each nutrient and life stage group. Extrapolation
is always the second choice, and the use of inno-
vative, non-invasive methods or of existing meth-
ods (e.g. stable isotopes) is encouraged to deter-
mine nutrient requirements of infants, children
and adolescents [8].

Conclusions

• NIV provide an estimate for adequate nutrient
  provision to populations considered healthy,
  but they do not determine the optimal nutri-
  ent supply for an individual


• PRI (also called reference nutrient intakes or
  RDA) are the levels of intake that meet the
  needs of almost all healthy individuals of a giv-
  en age and sex group


• The diet for healthy children should generally
  provide nutrient intakes matching the PRI, ex-
  cept for energy, where ANR provide guidance
  on appropriate intakes for groups


• Children affected by disease or malnutrition,
  or those in whom catch-up growth is desired,
  may have nutrient needs that differ markedly
  from PRI

Acknowledgements

The author’s work is carried out with partial financial sup-

port from the Commission of the European Communi-

ties, the 7th Framework Programme, contract FP7-

289346-EARLY NUTRITION, and the European Re-

search Council Advanced Grant ERC-2012-AdG – No.

322605 META-GROWTH. This manuscript does not

necessarily reflect the views of the Commission and in no

way anticipates the future policy in this area.

B, Hermoso M, Pena Quintana L, Gar-

cia-Luzardo MR, Santana-Salguero B,

Garcia-Santos Y, Vucic V, Andersen LF,

Perez-Rodrigo C, Aranceta J, Cavelaars

A, Decsi T, Serra-Majem L, Gurinovic

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DOI: 10.1159/000369234