Interactions between 2H and 18O natural abundance variations and DLW measurements of energy expenditure

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

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.

Efficiency of autoregulatory homeostatic responses to imposed caloric excess in lean men

Obesity implies a failure of autoregulatory homeostatic responses to caloric excess. We studied the mechanisms, effectiveness, and limits of such responses in six lean (21.9 +/- 1.3 kg/m(2)), healthy men based in a metabolic suite for 17 wk of progressive intermittent overfeeding (OF) (3 wk, baseline; 3 wk, 20% OF; 1 wk, ad libitum; 3 wk, 40% OF; 1 wk, ad libitum; 3 wk, 60% OF; 3 wk, ad libitum). Body composition was assessed by a four-compartment model using dual X-ray absorptiometry, deuterium dilution, and plethysmography. Magnetic resonance imaging assessed subcutaneous/visceral fat at abdominal level at baseline and at the end of 60% OF. Energy intake was assessed throughout, energy expenditure (EE) and substrate oxidation rates were measured repeatedly by whole body calorimetry (calEE), and free-living EE (TEE) was measured by doubly labeled water at baseline and after 60% OF. At the end of 60% OF, calEE and TEE had increased by just 11.4% (P = 0.001) and 16.2% (P = 0.001), respectively. Weight and body fat (fat mass) had increased by 5.98 kg (8.8%, P = 0.001) and 3.31 kg (22.6%, P = 0.01), respectively. The relative increase in visceral fat (32.6%, P = 0.02) exceeded that of subcutaneous fat (13.3%, P = 0.002) in the abdominal region. The computed energy cost of tissue accretion differed from the excess ingested by only 13.1% (using calEE) and 11.6% (using TEE), indicating an absence of effective dissipative mechanisms. We conclude that elevations in EE provide very limited autoregulatory capacity in body weight regulation, and that regulation must be dominated by hypothalamic modulation of energy intake. This result supports present conclusions from genetic studies in which all known causes of human obesity are related to defects in the regulation of appetite.

The role of technology in the past and future development of the doubly labelled water method

The doubly labelled water method is an isotope-based technique that is used to measure the energy demands of free-living animals and humans. It is based on the observation that, in the body, the oxygen in carbon dioxide is in complete isotope exchange equilibrium with the oxygen in body water. Hence, a label of isotopic oxygen in body water is eliminated by both respiratory CO(2) and water turnover, whereas a similarly introduced label of deuterium is eliminated only by water flux. The difference in isotope fluxes therefore permits estimation of CO(2) production, which is correlated to energy demands. The doubly labelled water method has been advanced predominantly by technological advances in mass spectrometry. Although it was first described in the 1950s, it was only used on small animals and in low numbers because the costs of the isotopes were a primary constraint. However, advances in mass spectrometry precision and accuracy in the 1980s made it possible to reduce the quantities of isotope used, and hence apply the method on humans, although still in small numbers. The advent of continuous flow inlets in the 1990s made possible the processing of samples in much larger numbers and the sample sizes of studies have expanded. Ironically, however, the technique is now under treat because of technological advances in another area (positron emission tomography), which has generated an enormous demand for (18)O and pushed up the price of isotopes. A continuation of this trend might drive prices to levels where sustained application of the method in human studies is questionable. Replacing determination of isotope enrichments currently performed by isotope ratio mass spectrometry with determinations made by stable isotope infrared laser spectrometry may be a technological advance that will get us out of this problem.

Natural abundance deuterium and 18-oxygen effects on the precision of the doubly labeled water method

The doubly labeled water method for measuring total energy expenditure is subject to error from natural variations in the background 2H and 18O in body water. There is disagreement as to whether the variations in background abundances of the two stable isotopes covary and what relative doses of 2H and 18O minimize the impact of variation on the precision of the method. We have performed two studies to investigate the amount and covariance of the background variations. These were a study of urine collected weekly from eight subjects who remained in the Madison, WI locale for 6 wk and frequent urine samples from 14 subjects during round-trip travel to a locale > or = 500 miles from Madison, WI. Background variation in excess of analytical error was detected in six of the eight nontravelers, and covariance was demonstrated in four subjects. Background variation was detected in all 14 travelers, and covariance was demonstrated in 11 subjects. The median slopes of the regression lines of delta2H vs. delta18O were 6 and 7, respectively. Modeling indicated that 2H and 18O doses yielding a 6:1 ratio of final enrichments should minimize this error introduced to the doubly labeled water method.