Role of disease in energy balance in children

Nutritional stress can be caused by increased energy demands or inadequate caloric intake. In the absence of food shortage, disease is often a significant contributory factor in promoting nutritional stress. In children, the interaction of nutrition and disease is more difficult to assess than in adults because deficits in growth and development have both a determining and consequential role in defining energy needs. This paper presents a framework for examining the role of disease in energy balance in children and gives three examples of disease-energy balance interactions. Resting and total energy expenditure (REE and TEE) and growth and body composition were measured in children with spastic quadriplegic cerebral palsy (SQCP) and cystic fibrosis (CF) and compared to normal children. Different patterns of energy balance emerged, with REE and TEE being lower in children with SQCP, and REE being higher in children with CF compared to controls. Clinical evaluations of REE in patients evaluated for failure-to-thrive and obesity indicated substantial variability in energy requirements relative to predicted values. These disease models demonstrate that the effect of disease on energy balance in children is diverse. Further studies quantifying the components of energy balance are needed to understand the mechanisms of nutritional adaptation during growth and development under the broad range of human conditions.