title: Revision of Dietary Reference Intakes for energy in preschool-age children.
abstract: BACKGROUND
  Dietary Reference Intakes (DRI) for energy aim to balance energy expenditure at a level of physical activity consistent with health and support adequate growth in children. DRIs were derived from total energy expenditure (TEE) measured by using the doubly labeled water (DLW) method; however, the database was limited in the 3-5-y-old range.
  
  
  OBJECTIVE
  We reexamined the DRI for energy for preschool-age children.
  
  
  METHODS
  Ninety-seven healthy, normal-weight, preschool-age children (mean ± SD age: 4.5 ± 0.9 y) completed a 7-d DLW protocol while wearing accelerometer and heart rate-monitoring devices.
  
  
  RESULTS
  Mean TEE and physical activity level (PAL) averaged 1159 ± 171 kcal/d and 1.34 ± 0.14, respectively. TEE predicted by DRI equations agreed with observed TEE (+34 kcal/d or 3%) if the sedentary PAL category was assumed but was overestimated by using the low active (+219 kcal/d or 19%), active (398 kcal/d or 34%), and very active (593 kcal/d or 51%) PAL categories. PAL categories were redefined on the basis of the narrower PAL range observed in preschoolers (range: 1.05-1.70) compared with older children and adults (range: 1.0-2.5). Sex-specific nonlinear regression models were newly developed to predict TEE from age, weight, height, and new PAL categories. The mean absolute error of TEE prediction equations was 0.00 ± 35 kcal/d or 0.1 ± 3%. Ancillary measures, such as total accelerometer counts and total daily steps, that were significantly correlated (P = 0.01-0.05) with TEE (r = 0.26-0.38), TEE per kilogram (r = 0.31-0.41), and PAL (r = 0.36-0.48) may assist in the classification of preschoolers into PAL categories.
  
  
  CONCLUSIONS
  Current DRIs for energy overestimate energy requirements of preschool-age children because of the erroneous classification of children into PAL categories. New TEE prediction equations that are based on DLW and appropriate PAL categories are recommended for preschool-age children. This trial was registered at clinicaltrials.gov as H12067.
authors.affiliation: From the USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (NFB, WWW, TAW, ALA, and MRP), and the Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (IFZ).
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Butte
authors.affiliation: From the USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (NFB, WWW, TAW, ALA, and MRP), and the Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (IFZ).
authors.forename: William W
authors.initials: WW
authors.lastname: Wong
authors.affiliation: From the USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (NFB, WWW, TAW, ALA, and MRP), and the Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (IFZ).
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Wilson
authors.affiliation: From the USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (NFB, WWW, TAW, ALA, and MRP), and the Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (IFZ).
authors.forename: Anne L
authors.initials: AL
authors.lastname: Adolph
authors.affiliation: From the USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (NFB, WWW, TAW, ALA, and MRP), and the Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (IFZ).
authors.forename: Maurice R
authors.initials: MR
authors.lastname: Puyau
authors.affiliation: From the USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX (NFB, WWW, TAW, ALA, and MRP), and the Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (IFZ).
authors.forename: Issa F
authors.initials: IF
authors.lastname: Zakeri
mesh_terms: D061725:Accelerometry; D015992:Body Mass Index; D001835:Body Weight; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D017711:Nonlinear Dynamics; D009751:Nutritional Requirements; D064167:Recommended Dietary Allowances / Q000331:legislation & jurisprudence*