Nutritional Requirements

S A Atkinson, McMaster University, Hamilton, ON,

Canada

© 2005 Elsevier Ltd. All rights reserved.

Optimal nutritional support of infants in the first year of life is essential to attain normal trajectories of growth and development. Additionally, evidence supports the thesis that during critical periods of early development nutrition may be key to 'programming,' possibly through modification of gene expression or differential cell proliferation, that subsequently impacts on risk for chronic diseases in later life. Information on early nutrition programming is not sufficient to be used as a basis to set dietary standards for infants. However, the importance of adopting the quantity and quality of nutrients in human milk as a gold standard in the determination of nutrient recommendations has been reinforced by several agencies worldwide, such as the pioneering partnership between the Food and Nutrition Board of the Institute of Medicine in the United States and Health Canada.

Recommended nutrient intakes or dietary standards are produced by many countries as well as key international agencies such as the FAO/WHO. For infants, the recommended intakes are usually intended for term-born, healthy, and normally growing infants who have a birth weight of more than 2500 g (and thus not small for gestational age). In this article, the nutrient requirements outlined reflect recent reports of the Dietary Reference Intakes (DRIs) for the United States and Canada as published by the Institute of Medicine. For a summary of the range of recommended nutrient intakes for infants that reflect a review of several international reports, the reader is referred to the March of Dimes document, Nutrition Today Matters Tomorrow (Appendix D-2).

The key changes in the derivation of the DRIs for infants compared to previous dietary standards from the United States and Canada include adoption of human milk as the reference model for setting recommended nutrient intakes for infants; simplification of age groupings within the first year; no specific provision of dietary recommendations for formula-fed infants; and gender-specific DRI values for fewer nutrients and only where data were available to support such gender specificity. Another major change from previous dietary standards is that upper levels (ULs) for nutrient intake were defined for the first time. Unfortunately, for infants, few ULs were established due to a paucity of pertinent knowledge; even for ages 1-18 years, the UL values were mostly extrapolated from adult values.

This article provides an overview of key concepts and examples of the DRIs specific for infants, future needs for additional research, and practical aspects of meeting the dietary recommendations for infants.

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