Effects of caloric supplementation on growth in children with uremia

Growth and nutritional status were evaluated in 12 children with chronic renal insufficiency over a 2-year period. During 1 year the children received nutritional counseling but no caloric supplement; during year 2, they received both nutritional counseling and caloric supplementation. With caloric supplementation, food intake as a percent of normal increased from 73 to 103% and the rate of growth increased from 59 to 90% of expected. The deviation from normal for height, as measured by SD scores, did not improve during the period of supplementation, that is, there was no accelerated or compensatory growth. During the unsupplemented period growth rate, as percent normal, correlated with energy intake as percent normal (r = 0.68). Growth rate and energy intake did not correlate during the period of caloric supplementation. Anthropometric measurements and plasma albumin increased during the period of supplementation, but other indices of body protein mass did not change. Plasma lipid levels also rose with caloric supplementation. We interpret these findings as evidence that dietary energy deficiency exists in many children with chronic renal insufficiency and contributes to their poor growth. Caloric supplementation in children improves total energy intake, growth rate, and skinfold thickness, but it does not lead to accelerated or compensatory growth.