Developmental contributions to macronutrient selection: a randomized controlled trial in adult survivors of malnutrition

Background and objectives: Birthweight differences between kwashiorkorand marasmussuggest 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 proteinintake in adulthood is associated with birthweight, and that protein leveraging to maintain this target proteinintake would influence energy intake (EI) and body weight in adult survivors of malnutrition. Methodology: Sixty-three adult survivors of marasmusand kwashiorkorcould freely compose a diet from foods containing 10, 15 and 25 percentage energy from protein (percentage of energy derivedfrom 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 Conclusions and implications: 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.