13C abundances of nutrients and the effect of variations in 13C isotopic abundances of test meals formulated for 13CO2 breath tests

Abstract

Unlike 14CO2 breath tests, 13CO2 breath tests are performed in the presence of a large background of naturally occurring isotope. Because the exact abundance of 13CO2 in breath can be changed by variations in diet, a study of the 13C abundance of dietary constituents and their effects on breath 13CO2 has been undertaken. Dietary constituents have been combusted to CO2 and the relative abundance of 13C analyzed by mass spectrometry. Breath CO2 was collected and isotopically analyzed after the ingestion of several dietary constituents and test meals. The 13CO2 abundance of breath CO2 was shown to change in response to the 13C abundance of the substrate being oxidized. Conversely, a test meal that closely approximates the 13C abundance of fasting breath CO2 from North Americans was shown not to alter the 13CO2 abundance in breath. Investigation of the breath 13CO2 response to individual 13C-labeled dietary constituents demonstrated that amino acids produced the earliest 13CO2 response followed in order by medium chain triglycerides, carbohydrates, and long chain triglycerides. Because of the variation in 13C abundances in nature, the 13C abundance of any unlabeled substrate ingested during a 13CO2 breath test must be considered in order to eliminate artifacts that may reduce the sensitivity of the breath test or produce erroneous results. Methods for correcting breath tests for changes in background 13CO2 abundance are also discussed.