Energy Expenditure and Body Composition of Infants and Young Children (6-24 Months Old) in Asia

Determination of Energy Expenditure and Body Composition of Infants and Young Children (6-24 Months Old) in Asia Using the Doubly-Labelled Water (DLW) Technique

This project is a collaboration between International Atomic Energy Agency (IAEA), FAO Regional Office for Asia and The Pacific, and Mahidol University, Thailand to carry out the study on doubly-labeled water for assessment of total energy expenditure and body composition among infants and young children aged 6-23 months old. Thailand conducted a longitudinal study with participation from 4 other countries, namely, Pakistan, Philippines, Sri Lanka and Vietnam, in undertaking the same assessments in a cross-sectional design.

Study Overview

• Status: Active, not recruiting
• Conditions: Body Composition; Energy Expenditure; Infant and Young Child Feeding; Infants and Young Children
• Intervention / Treatment: Other: No intervention

Detailed Description

The current international recommendations on energy requirements for children aged 6-24 months were established based on data from the Western populations. More human data of healthy children from the developing countries where the living conditions may not be as favourable for child growth and development would be needed to ascertain the validity of the global recommendation. The role of the doubly-labelled water (DLW) technique in measuring total daily energy expenditure to derive energy requirements for humans was also highlighted. Low and middle income countries in Asian countries have undergone the nutrition transition and malnutrition on both ends of the spectrum emerge as significant nutrition challenges during this critical period of growth. Unfortunately, data on body composition, i.e., the relative amounts of fat and lean or fat-free tissue which constitutes quality normal growth beyond anthropometric measurements are scarce. These data will also be needed to guide the infant and young child feeding (IYCF) recommendations for good nutrition and health and to prevent all forms of malnutrition in the region.

This project addressed the need to fill the information gap for the region, and potentially be included for making revision on energy requirement recommendations for infants and young children (IYC) for Asia and beyond. Building on the previous technical cooperation between institutions in Southeast and South Asia with the International Atomic Energy Agency (IAEA) on stable isotopic techniques for health and nutrition well-being, this project is a collaboration between IAEA, FAO Regional Office for Asia and The Pacific, and Mahidol University, Thailand to carry out the study on doubly-labeled water for assessment of total energy expenditure and body composition among infants and young children aged 6-23 months old. Thailand conducted a longitudinal study with participation from 4 other countries, namely, Pakistan, Philippines, Sri Lanka and Vietnam, in undertaking the same assessments in a cross-sectional design.

• Study Type: Observational
• Enrollment (Actual): 391

Contacts and Locations

Study Locations

• Thailand
  • Nakhon Pathom
    • Salaya, Nakhon Pathom, Thailand, 73170
      • Institute of Nutrition, Mahidol University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Apparently healthy infants and young children aged 6-23 months of both sexes, belonging to the major ethnicity of the country, and having any socio-economic status.

Description

Inclusion Criteria for Mothers:

• Being aged >18 y old
• Being non-smoker
• Gestational age at delivery 37-41weeks
• Belonging to the major ethnicity of the country
• Having any socio-economic status
• Willing to sign informed written consent

Inclusion Criteria for Infants:

• Healthy baby
• Full term
• Having birth weight between 2.5 and 4.0 kg
• Height-for-age Z score and weight-for-height Z score at or above -2SD
• Being exclusively or predominantly breast-fed for at least 3 months

Exclusion Criteria for Mothers:

• Mothers: having chronic diseases, e.g., gestational diabetes were excluded.

Exclusion Criteria for Infants:

• Having inborn errors or chronic diseases e.g., celiac diseases
• Taking special supplement, e.g., RUTF.

Study Plan

How is the study designed?

Number of groups / cohorts

5

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Longitudinal study-Thailand; Cohort 1: 60 children were started at 6-8 months old, and were followed-up at 9-11, 12-14 and 15-17 months old. Cohort 2: 71 children were started at 12-14 months old, were followed-up 15-17, 18-21 and 21-24 months old.	Other: No intervention; No intervention
Cross-sectional study-Pakistan; Children aged 6-8, 9-11, 12-14, 15-17, 18-20, 21-23 months, both sexes.	Other: No intervention; No intervention
Cross-sectional study-Philippines; Children aged 6-8, 9-11, 12-14, 15-17, 18-20, 21-23 months, both sexes.	Other: No intervention; No intervention
Cross-sectional study-Sri Lanka; Children aged 6-8, 9-11, 12-14, 15-17, 18-20, 21-23 months, both sexes.	Other: No intervention; No intervention
Cross-sectional study-Vietnam; Children aged 6-8, 9-11, 12-14, 15-17, 18-20, 21-23 months, both sexes.	Other: No intervention; No intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Energy Expenditure	Total Energy Expenditure assessed using doubly labelled water (DLW) technique	assessed at aged 6-8, 9-11, 12-14, 15-17, 18-20, and 21-23 months
Body composition	Body composition assessed using doubly labelled water (DLW) technique	assessed at aged 6-8, 9-11, 12-14, 15-17, 18-20, and 21-23 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Weight	Body weight of infants in kilograms	assessed at aged 6-8, 9-11, 12-14, 15-17, 18-20, and 21-23 months
Length	Lenght of infants in centimeters	assessed at aged 6-8, 9-11, 12-14, 15-17, 18-20, and 21-23 months
Head circumference	Head circumference of infants in centimeters	assessed at aged 6-8, 9-11, 12-14, 15-17, 18-20, and 21-23 months
Mid-upper arm circumference	Mid-upper arm circumference of the left arm in centimeters	assessed at aged 6-8, 9-11, 12-14, 15-17, 18-20, and 21-23 months
Triceps skinfold thickness	Triceps skinfold thickness of the left arm in millimeters	assessed at aged 6-8, 9-11, 12-14, 15-17, 18-20, and 21-23 months
Subscapular skinfold thickness	Subscapular skinfold thickness of the left side in millimeters	assessed at aged 6-8, 9-11, 12-14, 15-17, 18-20, and 21-23 months
Infant and Young Child Feeding (IYCF)	IYCF indicators were determined using the IYCF questionnaire IYCF practices were assessed using the IYCF , breast milk intake, dietary intake	assessed at aged 6-8, 9-11, 12-14, 15-17, 18-20, and 21-23 months
Dietary intake	24-hr recall was administered for 3 days to obtain nutrient intakes from breast milk and diet	assessed at aged 6-8, 9-11, 12-14, 15-17, 18-20, and 21-23 months

Collaborators and Investigators

• Sponsor: Mahidol University
• Collaborators: International Atomic Energy Agency; Food and Nutrition Research Institute, Philippines; National Institute of Nutrition, Vietnam; Pakistan Institute of Nuclear Science and Technology (PINSTECH); Faculty of Medicine, University of Ruhuna, Sri Lanka; FAO
• Investigators: Principal Investigator: Tippawan Pongcharoen, PhD, Mahidol University

Publications and helpful links

General Publications

• Ua-Areechit T, Suteerojntrakool O, Pongcharoen T, Winichagoon P, Judprasong K, Murphy-Alford AJ, Lee WTK, Potip B, Sridonpai P, Tongchom W, Chomtho S. Breastfeeding duration is associated with higher adiposity at 6-8 months of age. Matern Child Nutr. 2023 Jan;19(1):e13438. doi: 10.1111/mcn.13438. Epub 2022 Oct 18.

Study record dates

Study Major Dates

• Study Start (Actual): January 21, 2020
• Primary Completion (Estimated): November 30, 2024
• Study Completion (Estimated): November 30, 2024

Study Registration Dates

• First Submitted: January 11, 2024
• First Submitted That Met QC Criteria: February 29, 2024
• First Posted (Actual): March 1, 2024

Study Record Updates

• Last Update Posted (Actual): March 1, 2024
• Last Update Submitted That Met QC Criteria: February 29, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Fat mass; Infant and young child feeding; Fat-free mass; Total energy expenditure; Doubly-labelled water; Children aged 6-24 months
• Other Study ID Numbers: LOA/RAP/2019/20

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: IAEA repository upon approval
• IPD Sharing Time Frame: 2025 onward
• IPD Sharing Access Criteria: Upon approval
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR