Special Considerations for Measuring Energy Expenditure with Doubly Labeled Water under Atypical Conditions.

Surabhi Bhutani

doi:10.4172/2165-7904.s5-002

Abstract

The global increase in the prevalence of obesity has dramatically increased interest in understanding the factors that influence human total energy expenditure (TEE). This in turn has increased interest in the doubly labeled water (DLW) method, a technique for measurement of total energy expenditure in free-living humans. The increasing use of this method is attributed to its portability, objectivity, minimal invasiveness, high accuracy and good precision. Although a relatively standard protocol for the method has emerged, the new generation of users often is unfamiliar with rationale behind aspects of the protocol as well as the approaches to avoid or correct for in situations that are not covered by the standard protocol procedure. The primary uncommon situations like introduction of isotopically different diet and fluids with or without geographical relocation, seasonal and temperature variations, activity level of participants etc. during or prior to the DLW measurements can lead to shift in baseline abundance of 2H and 18O or tracer elimination, resulting in moderate to large errors in the measured TEE. These unique situations call for special modifications to the conventional protocol to minimize errors. The objective of the present review was to assemble a list of frequently asked questions and the issues they represent, and then examine the available literature to describe and explain the modifications to the standard DLW protocol to maintain the method’s accuracy. This discussion of DLW protocol modification can be an excellent resource for investigators who intend to use this measurement technique for interesting and uncommon study designs.

Highlights

The estimation of energy expenditure in free-living organisms has been recognized for years to be central to understanding energy balance
One of the most impactful advances in the measurement of energy expenditure was the development of the Doubly Labeled Water (DLW) method by Lifson and McClintock, which was first validated in animals in 1955 [1]
If all assumptions upon which this method relies are satisfied, human energy expenditure can be measured with 2% accuracy and 2–10% precision using a standard DLW protocol [3]

Summary

Introduction

The estimation of energy expenditure in free-living organisms has been recognized for years to be central to understanding energy balance. One of the most impactful advances in the measurement of energy expenditure was the development of the Doubly Labeled Water (DLW) method by Lifson and McClintock, which was first validated in animals in 1955 [1]. It was not until twenty-five years later, that Schoeller and Van Santen successfully applied this method in humans [2]. The main purpose of the present review is to (i) summarize the rationale for the DLW standard protocol, (ii) identify those unusual study situations where the accuracy of the doubly labeled water method would be impacted and (iii) discuss approaches and options to avoid or correct for such variations

Objectives

Findings

Conclusion