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APPEND IX ENERGY NEEDS FOR RECOVERY FROM THE EFFECTS OF DIARRHEA Tables A-1 and A-2 present the subcommittee's estimates of the amounts of energy that must be consumed for various periods to petit nutritional recovery after diarrhea. The figures are based on several assumptions regarding weight loss during illness (0, 250, or 500 g), preillness nutritional status (95%, 90Z, or 80% of expected weight for length), and period of recovery to preillness weight or to 95% of expected weight for length (5, 10, or 20 days). Examination of the tables suggests the following general conclusions: The estimates for required energy intake for no weight loss during illness and for children initially at 95% of expected weight for length are reasonably close to the FAo/WH014 recommendations for age. The FAD/WHO are 110, 105, and 100 kcal/day for ages of 6, 12, values and 24 months, respectively. A smaller daily weight gain and hence a lower daily energy consumption are acceptable if the recovery period is longer. . Younger children must gain more weight daily, and hence consume more energy, than older children for any given set of assumptions regarding severity of illness-induced weight loss, nutritional status, or duration of recovery. 0 To reach normal weight, children who were already undernourished must gain more weight daily than adequately nourished children, if gain is expressed as a fraction of body weight; thus, they must consume more energy. 31
· Younger children, especially if undernourished before illness, with greater illness-induced weight loss usually require more than 2 weeks of convalescence to replace lost weight and substantially more time to achieve 95% of expected weight for length. · Even older children require more than 2 weeks to recover nutritionally if they were already undernourished, particularly if the goal is to achieve 95% of expected weight for length. To relate Table 2 to Tables A-1 and A-2, one would have to correct the densities in Table 2 for the desired energy intake per day. For example, a 6 month-old child whose preillness weight for length was 90% of expected and who lost 250 g during illness would require 166 kcal/kg-day or 1195 kcal/day to recover the lost weight in 5 days. Such a child would require a minimal energy intake of 80 kcal/100 ml--1001195 kcal per day/6/250 ml if receiving six feedings per day. Because the maximal energy density usually recommended for young children 100 kcal/100 ml, it is obvious that more feedings per day would be required to achieve some of the higher growth rates shown in Tables A-1 and A-2. - 32
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