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

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Background The protein requirement of clinically normal but chronically undernourished (stunted) children is unknown. Stressors, like 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. Objective 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 (IAAO) technique. Design Eighteen undernourished school-age South Indian children (6–11y old) were studied before and after treatment for confirmed presence of intestinal parasites. They were randomized to receive a low or high protein intake from a range of 8 protein levels (0.24-2.38 g·kg -1 ·d -1 ) , 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 (REE). A constant and generous intake of the indicator amino acid (phenylalanine and its metabolite tyrosine) was ensured across all intake levels. A 2-phase linear regression crossover analysis of the pattern of 13 C-phenylalanine oxidation (F 13 CO 2 ) across the protein intake levels before and after treatment, identified a minimal oxidation breakpoint that represented the mean protein requirement. Results The mean (95% CI) protein requirement of undernourished school age South Indian children with intestinal parasites was determined to be 1.25 (1.0,1.5) g·kg -1 ·d -1 . After anti-parasite treatment, the requirement was not different at 1.43 (1.1,1.8) g·kg -1 ·d -1 . Conclusion The presence of intestinal parasites does not increase the protein requirement of undernourished Indian children. However, the current mean (+2 SD) protein requirement of 0.76 (0.95) g·kg -1 ·d -1 might be inadequate for this group.