Doubly labelled water assessment of energy expenditure: principle, practice, and promise

• Published in: European journal of applied physiology Vol. 117; no. 7; pp. 1277 - 1285
• Main Author: Westerterp, Klaas R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2017; Springer Nature B.V
• Subjects: Biomedicine; Body composition; Body mass; Body water; Carbon dioxide; Deuterium Oxide - chemistry; Deuterium Oxide - pharmacokinetics; Energy; Energy balance; Energy expenditure; Energy Metabolism; Ergometry - methods; Exercise; Foundational Insights into the Estimation of Whole-body Metabolic Rate; Human Physiology; Humans; Hydration; Invited Review; Isotopes; Laboratories; Mass spectroscopy; Occupational Medicine/Industrial Medicine; Oxygen; Oxygen Isotopes - pharmacokinetics; Physical activity; Saliva; Sports Medicine; Urine; Water measurement; Energy intake; Energy requirement; Physical activity; Body mass regulation; Energy expenditure; Doubly labelled water; Carbon dioxide production; Body composition; Motion sensors
• ISSN: 1439-6319; 1439-6327; 1439-6327
• DOI: 10.1007/s00421-017-3641-x

The doubly labelled water method for the assessment of energy expenditure was first published in 1955, application in humans started in 1982, and it has become the gold standard for human energy requirement under daily living conditions. The method involves enriching the body water of a subject with heavy hydrogen ( 2 H) and heavy oxygen ( 18 O), and then determining the difference in washout kinetics between both isotopes, being a function of carbon dioxide production. In practice, subjects get a measured amount of doubly labelled water ( 2 H 2 18 O) to increase background enrichment of body water for 18 O of 2000 ppm with at least 180 ppm and background enrichment of body water for 2 H of 150 ppm with 120 ppm. Subsequently, the difference between the apparent turnover rates of the hydrogen and oxygen of body water is assessed from blood-, saliva-, or urine samples, collected at the start and end of the observation interval of 1–3 weeks. Samples are analyzed for 18 O and 2 H with isotope ratio mass spectrometry. The doubly labelled water method is the indicated method to measure energy expenditure in any environment, especially with regard to activity energy expenditure, without interference with the behavior of the subjects. Applications include the assessment of energy requirement from total energy expenditure, validation of dietary assessment methods and validation of physical activity assessment methods with doubly labelled water measured energy expenditure as reference, and studies on body mass regulation with energy expenditure as a determinant of energy balance.