Protein and Amino Acid Requirements in Human Nutrition (WHO Technical Report Series)

284 Pages·2007·4.03 MB·English

by  World Health Organization

WHWO HTeWOc hHTneOicc haTnle iRcchaenlp iRocaretlp RoSreetpr ioSerestr iSeesries
93 5 93 5 935
P P P PPRPROROTEOTIETNIEN IAN AN ANDND AD AM AMIMNINOINO AO AC IACDICDID
R R R
TheT WheTo Whrledo WrHldeo arHlldteh aH Oltehrag Oltahrng iOzaarngtiizaoannti izoaanntd ioa nnthd ae nt Fhdeo t oFhdeo oaFdnod oa dnAd ga rnAicdgu rAlitcugurrleitcu urletu re O O O
T T T
OrgOarngiOzaarngtiizaoannti izohanatv iohena wv heoa rwvkeoe rdwk oetordk qetoud a qtnout aiqfynu ttaihfyne tt iehfyne te ehrngee ye rangneyd rag nnyd ua tnnridue tnnrtiue tnrtie nt E E E RREQREQEUQUIRUIREIMREMEEMNENETSNT STI NSI NIN
I I I
N N N
neendese nodefse podofs p pouofl apptuoiolapntusiol asntisino csneisn 1cs9ein 41c99e. 4 199.4 9.
A A A
N N N HHUHUMUMAMANAN NN NU NUTRUTRITTRIITOIITONIONN
D D D

ThisT hisisT t hhisies t lhiaset et lhasett e ilnas tta ei nss tea ir nise easr isoeefs r rioeefps rooerfpt sroe rtpthsoa rttth asa imtth a atimto a ptimoro pvtorido pev:ridoev:ide: A A A
M M M
• • upd• uaptde uasp tdoeans t oepnsro optenroi npt eraoinnt deai nna dma naindmo a inamoci idnao cri edaq cruiediqr eruemiqreeumnirteesmn intes hn inets ah litneh ah latehna dlathn dand I I I
N N N
O O O
disedaissedeai sfsoeear fsaoelrl faaoglrl e aa ggll erao gguerpo sgu rpaonsu dpa nsp drae npgdrne apgnrneta gannnta dan nlta dac ntlaadct itnlaagct itnmagto inmthgoe mtrhsoe;trhse;rs;

A A A
• • rec• roemc romemceomnmdeamntdieoanntdsio aontnsio onpnsro optenroi npt erroientq eruieniqr eruemiqreeumnirteesmn intes hn inets ah litneh ah latehna dlat hnd dias neddaiss edeai,sseea,se, C C C
I I I
D D D
incliundcliiunndgcl iunthdge intirhg ei mtirh peimliirc paimlticiopanlticsio afntosior fndoser vfdoeerlo vdpeelionvpgel ioncpgo iuncngot urcineotsur;inetsr;ies;
R R R
E E E
• •rec•oremcormemceomnmdeamntdioeanntdsio aontnsio opnnrso optenroi npt eqroinut aeqliinuty aq laiutnyad lai tnlyad ba enlaldlbi nelagllb infeoglrl i nfwogor frwoldorw rwliddowerl idduwsee idu.see u.se. Q Q Q
U U U
I I I
R R R
ThisT hreisTp hroeisrpt roperrpto opvrritdo pevsrido tevhside t ethose ot thlsoe ot otlso aotodls d atrode dsasrde pdsrsrae pcsrstai cpcartlai cqcautli ecqsautl ieoqsnutsieo sontnsio onns on E E E RepRoerpRt oeorpft oaor ftJ aoo finJ aot inJotint
M M M
thet ahdet eahqdeu eaaqdcuyea qocufy a foocfyo fdoo fos fudop ospudlpi espsul,pi etpasl,ri getaes,rt gst aefrotgsr e ffotosro ffdoo roa fdnod oa dnnd ua tnnridutio tnrniut iotrnit ion EN EN EN WHWOH/WOFHA/OOFA//OFUA/NOUU/N EUUxN pEUex rpEt exCrpto enCrstou nCltsoauntlitsoauntlitoantion
T T T
polpicoyl,pi caoynl,id ca ynla,d ba nelaldlbi nelagllb inoegfl l pinorgfo ptoerfoi npt erqoinut aeqliinuty aq.l iuIttya c.l ioItty nc. toIat ninctsoa nisntpsae isncpsifie sccp ifie cc ifi c S S S

I I I
recroemcromemceomnmdeamntdioeanntdsio afnotsior fnionsfr a fionnftra, inncftha,i lncdth ,ai lcdnhd ail dnad da unaldtd n uaultd tnuriutltio tnrniut.iotrnit.ion. N N N

H H H
U U U
M M M
ThisT hreisTp hroeisrpt roiesrp ta oinsr tea isnss eaesnns teeiasnls treieanfl etrireaefl enrrecefeen frcoeenr fctohero ftsohero wtsheho ows ehn oewe hndoe e tnode etod to
A A A
N N N
detdeermtdeiernmtee irtnhmee itn ahede t eahqdeu eaaqdcuyea qocufy a pocofy p pouofl apptuoiolapntu iofloanto iofdon oi nfdota oinkdeta sink; etsasek;t e snsea;t t snioeatnt aniola ntaiol nal

N N N
foofdo oafdnod oa dnnd ua tnnridutio tnrniut iotgrnuit iidogneul iidgneuelisidn eaelnsind ae nrsed ag nruedlag truieolagntusiol aontnsio otnhnse ot phner ot phteeroi npt eraoinntd ea innd a nd U U U
T T T
R R R
amainmo ainamoci idna occi doa ncctidoe nncttoe onnftt e inondft uinosdft ruiniasdtllruyias ptllrryioa pcllryeo spcsreeosdcs eefosdso efdodso ;f dodsoe; dtdeser;m tdeiernmtee irnme ine
I I I
T T T
nutnriuetnnrtiue ntnretiee nndetse ,n daesne,d da sne,d vaa neludvaa etlueva aatlnueda at need nas neudnres eu tnrheseu t rahede t eahqdeu eaaqdcuyea qocufy a rocafyt i rooanft siro antsio ns IO IO IO
N N N
for fvourl nfvoeurrl naveburllnea ebgrlerao bgulerpo sgu.r poTsuh. peT sth.o eTo thlsoe oi ntlso t ohinliss t hirneis pt hroeisrpt roceraptn oc raatln sc oaa lnbs oea lbusosee budse e uds ed
to mtoa mpto aa mpnd aa pnmd ao nmndito omnri togonlroi tbgolaro l bgfolaool bfdoa ols fhdoo osrhdtao sgrhteaosgr ateansgd ae nusd na dnuednr d-unenurd-tnreiutri-otnrniut iotrnit ion
WWW
throthurgothhu rgeoahur gelyah wr elyaa rwrnlyain rwgna insrygns insteygms stesy.mstes.ms. HHH
OOO
T T T
eee
ccc
ISBNIS 9B7N8IS 99B72N8 4 99 17228 40 9 91232 540 9913250 9935 9 hhh
nnn
icicic
aaa
l Rl Rl R
eee
ppp
ooo
rt Srt Srt S
eee
rierierie
sss
– – –
9 9 9
333
555
cvr 15.5mm spine.indd 1 11/12/07 4:56:45 PM
The WorlTdh eH eWaolthrl dO Hrgeaanltihz aOtiorng awniazsa tieosnt awbalissh eedst ainb lis1h9e4d8 ians 1a9 4s8p eacsi aaliz esdp ecialized
SELECTSEEDLE WCHTEOD P WUBHLOIC PAUTBIOLINCSA TOION NTSH EO NSA TMHEE TSHAEMMEE THEME
agency oaf gtheen Ucyn iotef dth Ne aUtinointesd s Neravtiinogn sa ss ethrvein dgir eacs ttihneg dainredc ctionogr dainnda tcinogo raduinthaotirnitgy authority
for internafotiro innatel rhneaatilothn aml ahtetearlsth a mnda tpteurbs liacn hde paultbh.li cO hneea oltfh W. OHnOe’s o cf oWnHstOitu’st iocnoanls titutional
functions fiusn tcot iponrosv iisd eto o pbrjoevcitdivee oabnjdec rteivliea balned in rfeolriambaleti oinnf oarnmda atidovni caen din atdhevi cfi ee ldin the fi eld WHO ChWildH GOr Cowhitlhd SGtaronwdathrd Sst:a Hndeaadrd csi:r cHuemadfe criernccuem-ffoerr-eangcee, -afromr- age, arm
of humano f hheuamltha, na hreeasltpho, nas ibreilistyp otnhsaitb iilti tyfu ltfih last init fpualfir tls thinro upgahrt itthsr oeuxgtehn sitisv ee xtensive circumfecriernccuem-ffoerr-eangcee, -tfroirc-eapgse s, ktrinicfeoplds- sfokrin-afogled, -afnord- asugeb,s acanpdu sluabr scapular
programmpero ogfr apmubmliec aotfi opnusb.lications. skinfold-sfokrin-afogled: -Mfoer-tahgoed:s Manedth doedvse alonpdm deenvtelopment
The OrgaTnhiez aOtiorng asneizeaktsio nth rsoeuegkhs itthsr opuugbhl icitast iopnusb ltioc astiuopnsp otrot nsautpiopnoartl hneaatiolthn al health 2007, ISB2N00 977, 8I S9B2 N4 917584 79128 45 ,1 253447 1p8ag5e, s234 pages
strategiess tarnadte gadiedsr easnsd tahded mreossst pthree smsionsgt ppruebslsicin hge paluthb lcico nhceearltnhs c oofn pcoeprnusla otifo pnos pulations
around thaer owunodrld t.h eTo w roerslpdo. nTdo rtoe stphoen nde teod sth eo f nMeeedmsb eorf MSteamtebs ear t Satall telesv ealts aollf levels of
GuidelineGsu oind eFlionoeds Fono rFtioo cda tFioonrt wi ictaht Mionic wrointhu tMriiecnrtosnutrients
developmdeenvte, lWopHmOe pnut,b WlisHhOes p purbalcisthiceasl pmraancutiaclasl, mhaanndubaloso, khsa nadndb otroakisn ianngd m traatein-ing mate-
2006, ISB2N00 967, 8I S9B2 N4 917589 49021 4 1 1, 5397400 p1a g1e, s370 pages
rial for spreiacl ifif ocr csapteecgiofi rcie csa otef ghoeraieltsh owf ohrekaelrtsh; winoterkrnearsti;o innatellyrn aaptiopnliaclalyb laep gpuliicdaeb-le guide-
lines and lisnteasn daanrdd ss;t arenvdiaerwdss ;a rnedv ieawnasl yasneds aonf ahleysaeltsh opfo hliceiaelsth, pprooligcriaems, mperosg aranmd mes and
research;r easneda srctaht;e a-onfd-t hseta-ater-t ocfo-tnhsee-anrstu cso rnespeonrstsu sth raetp oofrfetsr ttheacth onfifcear l taedchvinciec aal nadd vice and WHO ChWildH GOr Cowhitlhd SGtaronwdathrd Sst:a Lnednagrtdhs/:h Leiegnhgtt-hfo/hr-eaigghe,t -wfoerig-ahgte-f, owr-eaigghe,t-for-age,
recommernedcaotmiomnse nfodra tdioencsi sfioonr -dmeackiesirosn. -Tmhaekseer sb. oTohkess ea rbe ocolkoss ealyre ticeldo steol yt hteie d to the weight-fowr-eliegnhgtt-hfo, rw-leeingghtth-f, owr-ehigehigth-fto ar-nhde ibgohdty a mnda sbso idnyd mexa-fsos ri-nadgeex: -for-age:
OrganizaOtiorng’as npizriaotriiotyn ’sa cptrivioitriietys ,a ecnticvoitmiesp,a esnscinogm dpisaesasisneg p dreisveeansteio pn raenvedn ctioonnt raonl,d control, Methods Manedth doedvse alonpdm deenvtelopment
the develothpem deenvte olof pemqueintat bolfe e hqeuaitltahb sley shteeamltsh bsayssetedm osn b parsimeda royn h peraimltha crya rhee,a altnhd c are, and
2006, ISB2N00 967, 8I S9B2 N4 917584 69923 45 ,1 353426 9p3ag5e, s332 pages
health prohmeaolttiho np froorm inodtiiovnid fuoar lisn dainvdid cuoamlsm anudni ctieosm. mPruongitrieesss. Ptorwogarredsss b teotwtearr dhes ablteht ter health
for all alsfoor daellm aalnsod sd tehme agnldosb athl ed isgsloebmailn adtiisosne maninda teioxnc haanndg ee xocfh iannfogrem oaft ioinnf ormation
NutritionN auntdri taino nA acntidv ea Ln iAfec,t PivAeH LOife S, cPiAenHtiO c S Pciuebnltiica ct iPonu bNlioc.a 6ti1o2n No. 612
that drawtsh aotn d trhaew sk noonw ltehdeg ken oawndle degxpe earinedn ceex poef raielln WceH oOf ’sa lMl WemHbOe’sr cMoeumntbrieers c ountries
and the acnodlla bthoer actioolnla boof rwatoiorlnd olef awdoerrlsd inle apduebrlsic inh epaultbhl ica nhde athlthe abniodm tehdei cbailo medical 2005, ISB2N00 957, 8I S9B2 N7 59 71186 9122 785, 2115601 p2a g8e, s250 pages
sciences.sciences.
To ensureT oth een wsuidree stth ep owsisdibeslet pavoasislaibbleili tayv oafi laabutilhitoyr iotaf taivuet hinofroitramtivaeti oinnf oarnmda gtiounid -and guid- Vitamin aVnitda mMiinn earnadl RMeiqnueriraelm Reenqtus iirne mHeunmtsa inn N Huutmritainon Nutrition
ance on haenacleth o mn ahtetearlsth, WmHatOte rsse,c WurHeOs tsheec burroeasd t hinet ebrrnoaatdio innatel rdnisattrioibnuatli odnis otrfi bitus tion of its 2005, ISB2N00 957, 8I S9B2 N4 917584 69122 4 6 1, 5346601 p2a g6e, s360 pages
publicatiopnusb laicnadt ioennsc oaunrda geensc othueriar gterasn tshlaetiiro ntr aannsdla taiodna patnadti oand. aBpyt ahtieolnp.i nBgy toh elping to
promote panrodm porteo teacntd h pearoltthe cat nhde aplrthe vaenndt apnrde vceonnt taronl dd icsoenatsroel tdhirsoeuagsheo utht rothueg hout the
GuidelineGsu fiodre tlihnee Isn fpora ttiheen tI nTpreaatitemnet nTtr oeaf tSmeveenrte olyf SMevaelnreoluyr Mishaeldn oCuhriisldhreedn Children
world, WHwOor’sld b, oWoHksO c’so bntoroibkust ec oton taricbhuiteev itnog a tchheie Ovirngga nthizea Otiorng’as npizriantcioipna’sl porbinjeccip-al objec-
2004, ISB2N00 947, 8I S9B2 N4 917584 69029 4 6 1, 54486 p0a9g e6s, 48 pages
tive – the taivteta –in tmhee natt tbayin amll epnet obpyl ea lol fp tehoep hleig ohfe tshte p hoisgshibelset lpeovsesl iobfl eh eleavltehl .of health.
Guiding GPruiindciinpgle Ps rfionrc Fipeleeds ifnogr IFnefeadnitnsg a Inndf aYnotus nagn dC hYioldurnegn C dhuirldinrge nE dmuerrignegn Ecimesergencies
2004, ISB2N00 947, 8I S9B2 N4 917584 69026 4 5 1, 59466 p0a6g e5s, 96 pages
The WHOT hTeecWhHniOca lT eRcehpnoicrta lS Rereiepso rtm Sakeerise sa vmaailkaebsle atvhaei lafi bnldei ntghes ofi nf dvianrgiosu so f various
The optimThale douprtaimtioanl douf reaxtcioluns iovfe e bxrceluassitvfeee bdrineags. tAfe seydsitnegm. Aat iscy srteevmieawt.i c review.
internatioinnatel rgnraotuiopnsa ol fg eroxuppesrt so ft heaxtp perrotsv itdhea tW pHroOvi dweit hW tHheO lawtieths tt hsec ielantteifis ct sacniedn tifi c and
technical teacdhvnicicea lo na dav icber ooand ara nbgroea do f ramnegdeic oafl amnedd ipcaulb laicn dh epaultbhl ics uhbejeacltths . subjects. 2002, ISB2N00 927, 8I S9B2 N4 917589 59624 43 ,1 5509 5p6ag4e3s, 50 pages
MembersM oefm sbuecrhs eoxfp seurct hg reoxuppesr ts egrrvoeu pwsi tsheoruvte r ewmituhnoeurt arteiomnu inne rtahteioirn p ienr sthoeni-r person-
al capaciatile cs arpaathceitrie tsh arant haesr rtehparne saesn traetpivreess eonft agtoivveesr nomf egnotvse ornr moethnetsr boor doitehse;r bodies; The ManTahgeem Meannt aogf eNmuetnritt oiofn N iunt Mritaiojonr i nE mMearjgoern Ecimesergencies
their viewthse dir ov ineowt sn decoe nssoat rnilye creesfl seacrti lyth ree fld eecct istihoen sd eocr isthioen ss taotre dth ep osltiactye do f policy of
2000, ISB2N00 907, 8I S9B2 N4 917584 59220 4 4 1, 5244592 p0a g4e, s249 pages
WHO. AnW HaOnn. uAaln saunbnsucarilp tsiounb stcor ipthtiiosn steor ieths,is csoemripersis, incgo mapbroisuint gs ixa bsouuct h six such
reports, rceopsotsrt sC, HcFo s1ts6 8C.–H Fo r 1U68S.$– 1o5r 1U.–S $(C 1H5F1 .–1 2(8C.4H0F o1r 28 .U4S0 $ or1 1 5U.–S $in 115.– in
ComplemCeonmtaprlye mfeeendtianrgy o ffe yeoduinngg ocfh yilodurneng cinh idlderveenlo ipni ndge vceoluonptirnige sc:o Au nrterviieesw: Ao fr eview of
developindge vceoloupnitnrige sc).o uFnotrr iefusr)t.h eFro ri nffuorrtmheart ioinnf,o rpmleaatisoen ,c ponletaascet WcoHnOta cPtr eWssH,O Press,
World HeWalothrl dO Hrgeaanltizha Otiorng,a n2i0z aativoenn, u2e0 Aapvpeinau, e1 2A1p1p iGa,e n1e2v1a1 2G7e, nSewvait z2e7rl,a nSdw itzerland current sccuiernrtein tc skcnieonwtile cd gkenowledge
(tel.: +41( t2e2l. :7 [phone]; 9fa1x 3: 2+6441; f2a2x :7 [phone]; 9e1- m4a8i5l:7 b; oeo-mkoaridl:e [email protected];@ owr ho.int; or 1998, WH1O99/N8,U WTH/9O8./1N, U22T8/9 p8a.g1e, s228 pages
order onlionred eart hotntlpin:/e/w awt wht.twph:/o/w.inwtw/b.owohkoo.irndte/brso)o.korders).
WHO InforWmHaOtio Inn fPorromdautciotsn cParno dbuec otsb ctaainn ebde boyb ctaoinnetadc tbinyg c WonHtaOc tPinrges Ws,H O Press,
WHO, 121W1 HGOen, e1v2a1 12 7G, eSnweivtzae 2rl7a,n Sdw, Eitzmearlial: nbdo,o Ekmoradile: [email protected], @Fawxh +o4.in1t ,2 F2a 7x9 [phone]o9r1 48 57 or
by orderinbgy o onrldineer:i nwgw own.lwinheo: .winwt/bwo.wokhoor.dinet/rbsookorders
cvr 15.5mm spine.indd 2 11/13/07 8:20:54 AM
92-4-120935-6_FM_i
This report contains the collective views of an international group of experts and does not necessarily represent the decisions
or the stated policy of the World Health Organization, the Food and Agriculture Organization of the United Nations,
or the United Nations University
WHO Technical Report Series
935
PROTEIN AND AMINO ACID
REQUIREMENTS IN
HUMAN NUTRITION
Report of a Joint
WHO/FAO/UNU Expert Consultation
92-4-120935-6_FM_ii
WHO Library Cataloguing-in-Publication Data
Joint FAO/WHO/UNU Expert Consultation on Protein and Amino Acid Requirements in Human Nutrition
(2002 : Geneva, Switzerland)
Protein and amino acid requirements in human nutrition : report of a joint
FAO/WHO/UNU expert consultation.
(WHO technical report series ; no. 935)
1. Proteins. 2. Amino acids. 3. Nutritional requirements. I. World Health Organization. II. Food and
Agriculture Organization of the United Nations. III. United Nations University. IV. Title. V. Series.
ISBN 92 4 120935 6 (NLM classification: QU 145)
ISSN 0512-3054
© World Health Organization 2007
All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World
Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: [phone]; fax: [phone]
4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications –
whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address
(fax: [phone]; email: [email protected]).
The designations employed and the presentation of the material in this publication do not imply the expression
of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any
country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed
or recommended by the World Health Organization in preference to others of a similar nature that are not
mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial
capital letters.
All reasonable precautions have been taken by WHO to verify the information contained in this publication.
However, the published material is being distributed without warranty of any kind, either express or implied.
The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World
Health Organization be liable for damages arising from its use.
This publication contains the collective views of an international group of experts and does not necessarily
represent the decisions or the stated policy of the World Health Organization.
Typeset in India
Printed in Singapore
92-4-120935-6_FM_iii
Contents
1. Introduction 1
References 6
2. Conceptual framework for estimating protein and amino acid
requirements 9
2.1 Basic concepts 9
2.1.1 Metabolic demand 10
2.1.2 Growth 11
2.2 Dietary influences on demand 12
2.2.1 Energy 12
2.2.2 Micronutrients 12
2.2.3 Lifestyle and environmental influences 13
2.3 Achieving nitrogen balance 13
2.3.1 Maintenance amino acid catabolism and obligatory
nitrogen losses 15
2.3.2 Digestibility of dietary proteins 16
2.3.3 Protein quality: matching the supply to the demand 18
2.3.4 Protein utilization and nitrogen balance 19
2.4 Response to variation in protein intake 20
2.4.1 Changes in body composition 21
2.4.2 Labile protein reserves 21
2.4.3 Protein turnover and amino acid recycling 22
2.5 Definition of requirement 24
2.6 Adaptive mechanisms 24
2.6.1 Adaptation of amino acid oxidation 25
2.6.2 Adaptation of urea metabolism: nitrogen metabolism in
the lower gut 26
2.7 Summary metabolic model 27
References 30
3. Statistical concepts and procedures involved in deriving
recommendations for protein and amino acid requirements 35
3.1 Overview 35
3.2 Phases of requirement estimation 36
3.2.1 Gathering and screening the data 36
3.2.2 Estimating the requirements of individuals 37
3.2.3 Examining influential factors 37
3.2.4 Estimating the distribution of requirements within a
population 38
3.3 Reference requirements and intakes 39
3.3.1 Reference intakes and risk of dietary inadequacy for
individuals 39
3.3.2 Reference intakes and risk of dietary inadequacy for a
population 41
3.4 The cost of protein deficiency 45
References 47
iii
92-4-120935-6_FM_iv
4. General methods used for determining protein and amino acid
requirements 49
4.1 Nitrogen balance 49
4.1.1 Practical aspects 50
4.1.2 Data interpretation 51
4.1.3 Other factors 54
4.1.4 General conclusion on nitrogen balance 55
4.2 Carbon balance 55
4.2.1 Practical aspects 55
4.2.2 Specific protocols 57
4.2.3 The 24-hour protocol 58
4.2.4 The fed-only protocol 61
4.2.5 Short-term fasting/feeding protocol 62
4.2.6 Data interpretation 63
4.2.7 General conclusion on carbon balance method 65
4.3 Indicator amino acid method 65
4.3.1 General approach 65
4.3.2 Summary of indicator amino acid method 70
4.4 Predictions from the obligatory nitrogen loss 71
4.5 Indirect estimates through measurement of protein utilization 71
4.6 Conclusions 72
References 73
5. Protein–energy interactions 79
5.1 Energy intakes and protein requirements 79
5.1.1 Nitrogen retention and variable energy balance 79
5.1.2 Nitrogen retention and variable energy turnover 80
5.1.3 Energy intakes and the interpretation of requirement
studies 81
5.1.4 Protein–energy interactions in children 81
5.1.5 Protein-sparing effect of non-protein energy
substrates 82
5.2 The protein:energy ratio 83
5.2.1 Protein:energy ratios as a measure of dietary protein
quality 83
5.2.2 Protein:energy ratio of requirements and dietary
assessment 84
5.2.3 Derivation of reference protein:energy ratios 85
References 89
6. Protein quality evaluation 93
6.1 Prediction of protein quality: using the protein digestibility
corrected amino acid score (PDCAAS) approach 94
6.1.1 Protein digestibility 94
6.1.2 Biological value 95
6.1.3 Amino acid score 95
6.2 Current concerns about the protein digestibility corrected
amino acid score (PDCAAS) approach 96
6.3 Conclusions 99
References 101
iv
92-4-120935-6_FM_v
7. Protein requirements of adults, including older people, and
women during pregnancy and lactation 103
7.1 Evaluation of published nitrogen balance studies 104
7.1.1 Adjustment for dermal and miscellaneous nitrogen
losses 104
7.1.2 Statistical analysis of nitrogen balance data 105
7.2 Population distribution of protein requirement and determination
of the median 107
7.3 Estimation of the variability and population reference intakes 108
7.4 Basal metabolic demands: the obligatory nitrogen loss 109
7.5 Potentially important influential factors identified in the
meta-analysis 110
7.5.1 Dietary source of protein 111
7.5.2 Climate 112
7.5.3 Age 112
7.5.4 Sex 112
7.6 Comparison with previous reports and other information 112
7.6.1 Dietary source of protein 113
7.6.2 Protein requirement of elderly people 114
7.6.3 Protein requirement of women 116
7.7 Protein requirements during pregnancy 116
7.7.1 Factorial approach 117
7.7.2 Nitrogen balance 119
7.7.3 Recommendations for protein intake during
pregnancy 120
7.7.4 Diet interventions during pregnancy 121
7.7.5 Twin pregnancy 121
7.7.6 Adolescent pregnancy 121
7.8 Protein requirements during lactation 122
7.9 Areas of uncertainty 123
7.10 Summary of protein requirement values for adults, including
women during pregnancy and lactation 125
References 126
8. Amino acid requirements of adults 135
8.1 Requirements for indispensable amino acids 136
8.1.1 Lysine 136
8.1.2 Leucine 138
8.1.3 Isoleucine and valine 139
8.1.4 Threonine 140
8.1.5 Aromatic amino acids 141
8.1.6 Tryptophan 143
8.1.7 Sulfur amino acids 144
8.1.8 Histidine 146
8.2 Dispensable amino acids 148
8.3 Summary of amino acid requirements in adults 149
8.4 Safe intakes of indispensable amino acids 150
8.5 Indispensable amino acid requirements in elderly people 150
v
92-4-120935-6_FM_vi
8.6 Requirement values compared with the amino acid content of
food proteins and diets 151
References 152
9. Protein and amino acid requirements of infants and children 161
9.1 Maintenance requirement for protein 163
9.1.1 Interpretation of experimental information 163
9.1.2 Variability of maintenance 167
9.2 Protein deposition 167
9.2.1 Infants and young children, age 0–2 years 167
9.2.2 Children, age 4–18 years 168
9.2.3 Variability of protein deposition 170
9.2.4 Growth rates compared with previous estimates 171
9.3 Factorial estimates of protein requirements 171
9.3.1 Comparison with protein intakes of the breastfed infant 172
9.3.2 Implications of the estimated protein requirements for
formula-fed infants 174
9.3.3 Average protein requirements and safe levels for
infants and children from 6 months to 18 years 175
9.4 Amino acid requirements from infancy to 18 years 177
9.4.1 Infants up to 6 months 177
9.4.2 Older infants and children 178
References 182
10. Catch-up growth 185
10.1 Protein requirements for rapid weight gain in the wasted child 186
10.2 Catch-up in height in stunted children 189
References 191
11. Influence of infection on protein and amino acid requirements 195
11.1 Pattern of the protein and amino acid response to infection 196
11.2 Implications of HIV/AIDS 198
11.3 Recommendations for a protein allowance in infection 199
References 203
12. Implications of the protein and amino acid requirements
for populations in developed and developing countries 207
12.1 Protein intakes of infants associated with adequate growth
rates 208
12.2 Population intakes and the new requirement values 212
12.3 Implications of the apparent inadequacy of the diets in
developing countries 218
References 221
13. Protein intake and health 223
13.1 Renal function 224
13.2 Bone health 224
13.3 Kidney stones 226
vi
92-4-120935-6_FM_vii
13.4 Cardiovascular disease 227
13.5 Cancer 229
13.6 Is there a maximum limit of dietary protein intake? 230
13.7 Conclusions 232
References 233
14. Summary of requirements 241
14.1 Derivation of requirements 241
14.1.1 Safe intake for individuals and populations 241
14.1.2 Precision of estimates 241
14.1.3 Age ranges 242
14.1.4 Relation to body weight 242
14.1.5 Corrections for characteristics of the diet 242
14.2 Protein requirements of adults 242
14.3 Protein requirements of infants, children and adolescents 243
14.4 Protein requirements of women during pregnancy and
lactation 244
14.5 Amino acid requirements and scoring pattern of adults 245
14.6 Amino acid requirements and scoring pattern of infants,
children and adolescents 245
14.7 Corrections for protein quality of the diet 245
14.8 Protein density of foods and the protein:energy ratio of the
requirements 246
References 247
15. Research needs 249
15.1 Recommendations for future research 250
15.2 Regulatory issues 254
References 255
Acknowledgements 257
Annex. Statistical procedures 259
Derivation of reference protein:energy ratio, individual diets 259
Estimation of distribution parameters 260
Regression 260
Analysis of variance 264
References 265
vii
92-4-120935-6_FM_viii