Calorie requirements for growth after severe undernutrition.

There are some apparently very discordant findings in the literature about the effect of undernutrition on oxygen consumption and the metabolic requirements for subsequent growth. Difficulties began to arise more than 50 years ago when Benedict and Talbot (1914), Murlin and Hoobler (1915), and Fleming (1921) agreed in finding that, 'the heat production per kilogram body weight is higher in the malnourished or marasmic infant than in the normal infant' (Talbot, 1921). The approximate figures were 80 and 55 kcal./kg. 24 hours, respectively, and these findings were subsequently confirmed (Fleming and Hutchison, 1924; Levine, Wilson, and Gottschall, 1928; Garot, 1933; Janet and Bochet, 1933; Kerpel-Fronius et al., 1951). These results are quite out of line with the findings in undernourished adults, who have always been found to have cold skins and subnormal resting metabolic rates per kilogram body weight (Zuntz and Loewy, 1918; Keys et al., 1950; Kerpel-Fronius, Varga, and Kun, 1954). Further confirmatory evidence was given by McCance and Mount (1960). Montgomery (1962), moreover, did not confirm them in children, for he found that on admission the resting metabolic rates were low or within normal limits. M6nckeberg et al. (1964) found the same so long as the children were not gaining weight. They rose, however, considerably during treatment, and reached figures of 60 to 90 kcal./kg. 24 hours if the weight began to rise satisfactorily. The earlier workers appear to have studied many of their cases during this phase as did Monckeberg et al., and this may help to explain the level of their results. The work on animals has been more consistent for, whether young or old, undernourished rats, pigs, and cockerels have always been found to have low resting metabolic rates compared with healthy normal animals of the same weight (Horst, Mendel, and Benedict, 1934; McCance and Mount, 1960;