skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Validation of doubly labeled water for measuring energy expenditure during parenteral nutrition

Abstract

The doubly labeled water method was compared with intake-balance for measuring energy expenditure in five patients receiving total parenteral nutrition (TPN). Because parenteral solutions were isotopically different from local water, patients had to be placed on TPN at least 10 days before the metabolic period. Approximately 0.1 g 2H2O and 0.25 g H2(18)O per kg total body water were given orally. We collected saliva before, 3 h, and 4 h after the dose for measurement of total body water and urine before, 1 day, and 14 days after the dose for measurement of isotope eliminations. On day 14, total body weight was remeasured and change in body energy stores was calculated, assuming constant hydration. Intake was assessed from weights of TPN fluids plus dietary record for any oral intake. Energy expenditure from doubly labeled water (+/- SD) averaged 3 +/- 6% greater than intake-balance. Doubly labeled water method is a noninvasive, nonrestrictive method for measuring energy expenditure in patients receiving TPN.

Authors:
; ;
Publication Date:
OSTI Identifier:
5095083
Resource Type:
Journal Article
Resource Relation:
Journal Name: Am. J. Clin. Nutr.; (United States); Journal Volume: 2
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BODY COMPOSITION; MEASURING METHODS; WATER; DEUTERIUM COMPOUNDS; DOUBLE LABELLING; INTRAVENOUS INJECTION; NUTRIENTS; PATIENTS; TRACER TECHNIQUES; HYDROGEN COMPOUNDS; INJECTION; INTAKE; ISOTOPE APPLICATIONS; LABELLING; OXYGEN COMPOUNDS; 550601* - Medicine- Unsealed Radionuclides in Diagnostics

Citation Formats

Schoeller, D.A., Kushner, R.F., and Jones, P.J. Validation of doubly labeled water for measuring energy expenditure during parenteral nutrition. United States: N. p., 1986. Web.
Schoeller, D.A., Kushner, R.F., & Jones, P.J. Validation of doubly labeled water for measuring energy expenditure during parenteral nutrition. United States.
Schoeller, D.A., Kushner, R.F., and Jones, P.J. 1986. "Validation of doubly labeled water for measuring energy expenditure during parenteral nutrition". United States. doi:.
@article{osti_5095083,
title = {Validation of doubly labeled water for measuring energy expenditure during parenteral nutrition},
author = {Schoeller, D.A. and Kushner, R.F. and Jones, P.J.},
abstractNote = {The doubly labeled water method was compared with intake-balance for measuring energy expenditure in five patients receiving total parenteral nutrition (TPN). Because parenteral solutions were isotopically different from local water, patients had to be placed on TPN at least 10 days before the metabolic period. Approximately 0.1 g 2H2O and 0.25 g H2(18)O per kg total body water were given orally. We collected saliva before, 3 h, and 4 h after the dose for measurement of total body water and urine before, 1 day, and 14 days after the dose for measurement of isotope eliminations. On day 14, total body weight was remeasured and change in body energy stores was calculated, assuming constant hydration. Intake was assessed from weights of TPN fluids plus dietary record for any oral intake. Energy expenditure from doubly labeled water (+/- SD) averaged 3 +/- 6% greater than intake-balance. Doubly labeled water method is a noninvasive, nonrestrictive method for measuring energy expenditure in patients receiving TPN.},
doi = {},
journal = {Am. J. Clin. Nutr.; (United States)},
number = ,
volume = 2,
place = {United States},
year = 1986,
month = 8
}
  • Change in abundance of /sup 2/H and /sup 18/O in dietary water during a doubly labeled water energy period may introduce error into the calculated carbon dioxide production rate (RCO/sub 2/). To examine the accuracy of /sup 2/H/sub 2/(/sup 18/)O during changing nutritional regimens, we compared /sup 2/H/sub 2/(/sup 18/)O and periodic open-circuit respiratory gas exchange (RGE) in postsurgical infants who were changing from parenteral to alternative parenteral and/or oral nutrition. The two methods were compared before and after correction for shifts in isotopic abundance of the infant water pools during the energy-expenditure period. Baseline corrections were predicted using themore » difference between abundances of the initial body water and final nutrient solutions. Before isotopic correction, /sup 2/H/sub 2/(/sup 18/)O underestimated RCO/sub 2/ in eight subjects by 11.8 +/- 20.1% (mean +/- SD). After correction, agreement between the two methods improved; the underestimate was then -8.7 +/- 12.9%. To obtain maximum precision of /sup 2/H/sub 2/(/sup 18/)O, subjects should be maintained on the same nutritional regimen before and during the study unless valid correction formulae are used.« less
  • To further validate the doubly labeled water method for measurement of CO/sub 2/ production and energy expenditure in humans, we compared it with near-continuous respiratory gas exchange in nine healthy young adult males. Subjects were housed in a respiratory chamber for 4 days. Each received /sup 2/H/sub 2/(18)O at either a low (n = 6) or a moderate (n = 3) isotope dose. Low and moderate doses produced initial /sup 2/H enrichments of 5 and 10 X 10(-3) atom percent excess, respectively, and initial 18O enrichments of 2 and 2.5 X 10(-2) atom percent excess, respectively. Total body water wasmore » calculated from isotope dilution in saliva collected at 4 and 5 h after the dose. CO/sub 2/ production was calculated by the two-point method using the isotopic enrichments of urines collected just before each subject entered and left the chamber. Isotope enrichments relative to predose samples were measured by isotope ratio mass spectrometry. At low isotope dose, doubly labeled water overestimated average daily energy expenditure by 8 +/- 9% (SD) (range -7 to 22%). At moderate dose the difference was reduced to +4 +/- 5% (range 0-9%). The isotope elimination curves for /sup 2/H and 18O from serial urines collected from one of the subjects showed expected diurnal variations but were otherwise quite smooth. The overestimate may be due to approximations in the corrections for isotope fractionation and isotope dilution. An alternative approach to the corrections is presented that reduces the overestimate to 1%.« less
  • Energy expenditure (EE) of four adult men on a weight-maintenance diet was estimated by use of doubly labeled water, intake balance, and direct and indirect calorimetry. The doubly labeled water (2H218O) method was used to estimate free-living EE for 13 d. Metabolizable energy (ME) intake was used to estimate free-living EE for 1 wk. The subjects' 24-h EE was measured in a dual direct-indirect room calorimeter on 3 alternate days. Estimates of free-living EE as measured by ME intake and doubly labeled water indicate agreement between the two methods (mean difference +/- SEM, -1.04 +/- 0.63%). Measurements of EE withmore » indirect and direct calorimetry are equivalent (mean difference 0.63 +/- 0.44%). The daily EE measured by doubly labeled water in these free-living adults over a 13-d period was 15.01% greater than the 24-h EE measured within the calorimeter.« less
  • The doubly labeled water method was compared with indirect calorimetry and a nutrient-balance study for simultaneous determination of rates of CO/sub 2/ production, energy expenditure, and water intake over 5 days in four preterm infants. Additionally, metabolizable energy (ME) intake estimated using the isotope procedure (as energy expenditure plus an estimate for energy deposition based on weight gain), was compared to ME intake measured in the balance study. Compared to values obtained by traditional methods, calculated CO/sub 2/ production, energy expenditure, and water intake differed by -1.4 +/- 4.8% (SD), +0.3 +/- 2.6%, and +5.7 +/- 1.4%, respectively; the differencemore » in water intake was significant (p less than 0.05). Calculated ME intakes were 5.3 +/- 19.3% less than measured intakes, but the difference was not significant. These findings indicate that the doubly labeled water method can provide accurate information on rates of CO/sub 2/ production, energy expenditure, and water intake in preterm infants, but individual estimates of ME intake may be subject to substantial error.« less
  • Average daily energy expenditure determined by the doubly labeled water technique (dlwEE) was compared in six subjects (aged 20-30 y) over 2 wk under usual living conditions; average food energy intake and energy expenditure estimated from individual diary records of physical activity. In addition, energy expenditure was estimated from 24-h heart rate recordings carried out on two randomly chosen days of the 2-wk period. The group means of the dlwEE were 1.94 +/- 0.24 (means +/- SD) times larger than resting metabolic rate (= 1.94 met) and nearly identical to the average daily energy intake (1.93 +/- 0.23 met). Energymore » expenditure estimated from the diaries of activity and from the 24-h heart rate recording varied between 1.67 and 2.24 met depending on the calculation procedure. The dlwEE (1.94 +/- 0.24 met) is much higher than that recently determined for sedentary people (1.25 met) and thus explains that young students may achieve body weight balance with a relatively high daily food energy intake.« less