Energy Balance, Physical Activity, and Thermogenic Effect of Feeding in Premature Infants

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Abstract
In order to assess the contribution of the thermogenic effect of feeding and muscular activity to total energy expenditure, nine premature infants were studied for 2 consecutive days during which time repeated measurements of energy expenditure by indirect calorimetry were performed throughout the day, combined with a visual activity score based on body movement. The infants were growing at 16.6 ± 4.0 g/kg/day (mean ± SD) and received 110 ± 8 kcal/kg/day metabolizable energy (milk formula) and 522 ± 40 mg N/kg/day. Their total energy expenditure was 68 ± 4 kcal/kg/day indicating that 41 ± 7 kcal/kg/day was retained for growth. Based on the combination of energy + N balances it was estimated that 80% of the weight gain was fat-free tissue and 20% was fat tissue. The rate of energy expenditure measured minute-by-minute was significantly and linearly correlated with the activity score in both the premeal (r = 0.75; p < 0.001) and the postmeal periods (r = 0.74; p < 0.001) with no difference in the regression slope, but with a significant difference in intercept. In preset feeding schedules the latter allowed an estimation of the thermogenic effect without the confounding effect of activity. This was found to be 3.1 ± 1.8% when expressed as a percentage of metabolizable energy intake. However when the “classical‘’ approach was used as a comparison (integretation of extra energy expenditure induced by the meal), the thermogenic effect was found to be greater, i.e. 9.5 ± 3.8% of the meal's metabolizable energy, due to the superimposed effect of physical activity in the postprandial state. The study suggests that the intradaily variation in energy expenditure in premature infants nursed according to present day techniques is almost equally due to the thermogenic effect of feeding (3.2 kcal/kg/day), and to variations in muscular activity (3.6 kcal/kg/day) both representing a small fraction of the total energy expenditure in premature infants.