title: Developmental contributions to macronutrient selection: a randomized controlled trial in adult survivors of malnutrition.
abstract: OBJECTIVE
  Birthweight differences between kwashiorkor and marasmus suggest that intrauterine factors influence the development of these syndromes of malnutrition and may modulate risk of obesity through dietary intake. We tested the hypotheses that the target protein intake in adulthood is associated with birthweight, and that protein leveraging to maintain this target protein intake would influence energy intake (EI) and body weight in adult survivors of malnutrition.
  
  
  METHODS
  Sixty-three adult survivors of marasmus and kwashiorkor could freely compose a diet from foods containing 10, 15 and 25 percentage energy from protein (percentage of energy derived from protein (PEP); Phase 1) for 3 days. Participants were then randomized in Phase 2 (5 days) to diets with PEP fixed at 10%, 15% or 25%.
  
  
  RESULTS
  Self-selected PEP was similar in both groups. In the groups combined, selected PEP was 14.7, which differed significantly (P < 0.0001) from the null expectation (16.7%) of no selection. Self-selected PEP was inversely related to birthweight, the effect disappearing after adjusting for sex and current body weight. In Phase 2, PEP correlated inversely with EI (P = 0.002) and weight change from Phase 1 to 2 (P = 0.002). Protein intake increased with increasing PEP, but to a lesser extent than energy increased with decreasing PEP.
  
  
  CONCLUSIONS
  Macronutrient intakes were not independently related to birthweight or diagnosis. In a free-choice situation (Phase 1), subjects selected a dietary PEP significantly lower than random. Lower PEP diets induce increased energy and decreased protein intake, and are associated with weight gain.
authors.affiliation: UWI Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica.
authors.forename: Claudia P
authors.initials: CP
authors.lastname: Campbell
authors.affiliation: Liggins Institute and National Research Centre for Growth and Development, University of Auckland, Auckland, New Zealand Charles Perkins Centre and School of Biological Sciences, The University of Sydney, Sydney, NSW, Australia Faculty of Veterinary Sciences, The University of Sydney, Sydney, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Raubenheimer
authors.affiliation: Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica.
authors.forename: Asha V
authors.initials: AV
authors.lastname: Badaloo
authors.affiliation: Liggins Institute and National Research Centre for Growth and Development, University of Auckland, Auckland, New Zealand.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Gluckman
authors.affiliation: Liggins Institute and National Research Centre for Growth and Development, University of Auckland, Auckland, New Zealand.
authors.forename: Claudia
authors.initials: C
authors.lastname: Martinez
authors.affiliation: Charles Perkins Centre and School of Biological Sciences, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Gosby
authors.affiliation: Charles Perkins Centre and School of Biological Sciences, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Simpson
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
authors.forename: Clive
authors.initials: C
authors.lastname: Osmond
authors.affiliation: Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Boyne
authors.affiliation: UWI Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica terrence.forrester@uwimona.edu.jm.
authors.forename: Terrence E
authors.initials: TE
authors.lastname: Forrester
keywords: birthweight; macronutrient; malnutrition; protein; protein leverage
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