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Doubly Labeled Water (DLW) Method for Free Living Energy Expenditure: Theory and Application

Doubly Labeled Water (DLW) Method for Free Living Energy Expenditure: Theory and Application. Obesity Journal Club James P. DeLany March 17, 2009. Components of Energy Expenditure. Activity Monitor. Activity Monitor. Differential elimination of DLW dose

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Doubly Labeled Water (DLW) Method for Free Living Energy Expenditure: Theory and Application

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  1. Doubly Labeled Water (DLW) Method for Free Living Energy Expenditure: Theory and Application Obesity Journal Club James P. DeLany March 17, 2009

  2. Components of Energy Expenditure Activity Monitor Activity Monitor

  3. Differential elimination of DLW dose 18-oxygen leaves the body as CO2 and water Deuterium leaves the body as water CO2 production calculated by difference in elimination rates Doubly Labeled Water (DLW) Theory

  4. Doubly Labeled Water Protocol -1 0 7-14 • Baseline(s) • urine • Dose • 4.5 - 6 hr • urine • Midpoint ? • final urines

  5. Energy Expenditure Calculations

  6. Early Human validations of the doubly labeled water method

  7. Chamber Validation - during Caloric Restriction (NIA CALERIE Study, PBRC chambers) We found close agreement between EE measured in the metabolic chamber (1906 ± 327 kcal/d) and by DLW (1934±377 kcal/d) during CR.

  8. Back to Back Baseline DLW measurements demonstrate repeatability of measurement

  9. Advantages of Doubly Labeled Water Method • Accurate • Can be combined with other methods to obtain activity energy expenditure • True field technique for free living energy expenditure • no requirement for subject compliance • no equipment for subject to break • can be used to validate other techniques

  10. DLW Drawbacks • Cost of 18O labeled water • Need for expensive isotope ratio mass spectrometer and sample preparation systems • Technical difficulties • Not Trivial • A 1995 report “Multiple laboratory comparison of the doubly labeled water technique” found that some labs returned physiologically impossible results. • My lab was one of only 4 (of 18 labs in five countries) to be within 2% of the theoretical ko-kd, which is directly proportional to the measure of energy expenditure • Roberts, S.B., W. Dietz, T. Sharp, G.E. Dallal, and J.O. Hill, Multiple laboratory comparison of the doubly labeled water technique. Obes.Res., 1995. 3 Suppl 1: p. 3-13.

  11. Childhood Obesity

  12. The Baton Rouge Children’s Study: Longitudinal Study of Energy Metabolism and Body Composition. • Can we identify metabolic predictors of change in body fat in children? • Longitudinal study of children undergoing the pubertal growth spurt • Assess energy metabolism and body composition • Reexamine children after 2 years • 114 of 131 children enrolled in study were located, and agreed to participate in 2-y follow-up • equal number of lean and obese children • equal number of Black and white boys and girls

  13. Mobile Metabolic Lab

  14. Energy Expenditure Components Conducted at the School • TDEE (Total Daily Energy Expenditure) • Doubly Labeled Water • RMR (Resting Metabolic Rate) • metabolic carts with canopies (Sensormedics 2900Z) • 30 minute, after 30 minute rest • TEF (Thermic Effect of Food) • 3 hr TEF, liquid meal at 35% RMR • Urinary nitrogen used to calculate protein oxidation • Non-protein RQ used to calculate fat and carbohydrate oxidation

  15. Physical Activity • Energy expended in Physical Activity (AEE) • AEE = TDEE - RMR - TEF24h • Caltrac estimate of TDEE and AEE • Initial measurements in 96 children • 2 year follow-up in 35 children

  16. Subject Characteristics (at 2y follow-up) DeLany, J.P., G.A. Bray, D.W. Harsha, and J. Volaufova, Energy expenditure in African American and white boys and girls in a 2-y follow-up of the Baton Rouge Children's Study. Am J Clin Nutr, 2004. 79(2): p. 268-73.

  17. Energy Expenditure by GenderAdjusted for FFM

  18. Energy Expenditure by RaceAdjusted for FFM

  19. Change in Energy Expenditure over 2 y The children gained, on average, nearly 12 kg over the 2 year period.

  20. Correlation between Activity Energy Expenditure by Caltrac and by DLW

  21. Decrease in Activity Energy Expenditure by Caltrac and DLW (-RMR -TEF)

  22. Prediction of Change in % Body Fat DeLany, J., G. Bray, D. Harsha, and J. Volaufova, Energy Expenditure And Substrate Oxidation Predict Change in Body Fat In Children. Am J Clin Nutr, 2006. 84(4): p. 862-870.

  23. Change in % Body Fat over 2 years

  24. Metabolic Parameters (Initial measures) Predicting % Body Fat Change Over 2 Years.

  25. Prediction models of change in % fat

  26. Prediction models of change in % fat

  27. CALERIE: Intake & Expenditure During Caloric Restriction

  28. Acknowledgements • E Ravussin • D Williamson • J DeLany • S Smith • F Greenway • M Most • E Larson-Meyer • P Geiselman • A Deutsch • M Lefevre • J Volaufova • L Heilbronn • and the Pennington CALERIE Team • Ben Brooks • Annie Lewis • Evest Brusaurd

  29. Randomization Time -1 0 1 2 3 4 5 6 mo . Healthy Diet 25% CR LCD 800 kcal/d 25% CR + PA Feeding at PBRC Pilot Phase 6 month study:

  30. Application of DLW in CALERIE • Assess changes in energy expenditure in response to CR • Adherence - Intake during restriction (2wk) • If not in balance adjust for changes in body composition • Good for group means, not as good for individuals over such a short period • Adherence – Long term Intake: 3-6 months • Adjust for changes in body composition by DEXA • Errors associated with changes in body composition over this long period are greatly reduced.

  31. DLW vs. Reported and Provided Intake CALERIE PBRC BL1 & BL2 N=47 BL 1 BL2 reported Provided Intake DLW Intake DLW mean 2711 2130 2840 2829 SD 486 592 541 456 BL2 intake is what we actually fed to maintain weight. On a group basis, was nearly identical to DLW measure of TDEE. Reported intake (BL1) significantly lower than TDEE.

  32. Energy Balance Calculations of Intake over 6 months • Energy balance equation • During energy balance: EI = EE • During energy restriction: EI = EE + Δ Energy stores • EE from DLW • Estimate linear decline in EE from BL to 3 mo, and from 3 mo to 6 mo • Calculation of Δ Energy stores • DEXA at baseline, 3 months and 6 months • For weight loss: • 1g FM = 9.3 kcal and 1g FFM = 1.1 kcal • For weight gain • 1g FM = 13.1 kcal and 1g FFM = 2.2 kcal • Δ Energy Stores ΔFM x energy equivalent + ΔFFM x energy equivalent

  33. Measured intake very close to diets fed and “Adherence” to 25% CR Month 6 R2=0.71 Month 3 R2=0.93 20 ± 2% 24 ± 1% Calculated Energy Intake During first 3 months, participants were fed all meals on metabolic unit. Between months 3 and 5 participants were counseled on CR, while all meals were provided during mo 6.

  34. Weight loss during CR Redman, L.M., L.K. Heilbronn, C.K. Martin, L. deJonge, D.A. Williamson, J.P. DeLany, E. Ravussin, for the Pennington CALERIE team. Metabolic and behavioral compensations in response to caloric restriction: implications for the maintenance of weight loss. PLoS ONE, 2009. 4(2): p. e4377.

  35. Reduction in EE in response to CR: exercise (CR+EX) prevents reduction

  36. Military Nutrition StudyExtreme Energy Expenditure

  37. The Crucible • The United States Marine Corps (USMC) has a rigorous field training exercise (FEX) at the end of their basic recruit training course called the Crucible. • The Crucible is 54 h in duration and imposes multiple stressors on trainees to simulate the intense physical and cognitive strain of sustained combat operations. • During the Crucible, recruits work on a variety of physical and mental challenges for extended time periods, receive little sleep, are on restricted rations, and are subjected to environmental stress and emotional strain. • The Crucible also requires that women complete the same physically demanding tasks as men.

  38. Typical Actigraph Tracing

  39. High activity and little sleep

  40. Energy Expenditure in Men and Women during 54 h of Exercise and Caloric Deprivation Castellani, J.W., J.P. DeLany, C. O'Brien, R.W. Hoyt, W.R. Santee, and A.J. Young, Energy Expenditure in Men and Women during 54 h of Exercise and Caloric Deprivation. Med Sci Sports Exerc, 2006. 38(5): p. 894-900.

  41. Energy Expenditure and Balance

  42. Elderly

  43. TDEE (DLW) & RMR in Elderly Louisiana Healthy Aging Study Frisard, M.I., J.M. Fabre, R.A. Russell, C.M. King, J.P. DeLany, R.H. Wood, and E. Ravussin, Physical activity level and physical functionality in nonagenarians compared to individuals aged 60-74 years. J Gerontol A Biol Sci Med Sci, 2007. 62: p. 783-788.

  44. TDEE components and PAL p<0.001 AEE TEF RMR p<0.005

  45. Relationship between Continuous Scale Physical Functional Performance Test (CS-PFP) score and PAL

  46. Severe Obesity

  47. RENEW study (Class II and III Obese) • There are limited data addressing energy expenditure in severe obesity. • Energy expenditure will be studied at baseline and after 6 months of intervention. • The doubly-labeled water method will be used to measure total daily energy expenditure (TDEE). • Indirect calorimetry will be used to measure resting metabolic rate (RMR). • Physical activity will be measured using light-weight, wearable monitors. • NEAT will be calculated using these measurements. • Comparisons will be between the groups with Class II and III obesity with further analysis for effects of ethnicity. • These findings will be compared to lean control subjects. • The effect of intervention will be examined • Exercise – adherence to increased physical activity prescription • Change with weight loss – Anticipatea lower decrease in TDEE in exercise group with weight loss

  48. Baseline TDEE

  49. Comparison of Class II & III vs. overweight (CALERIE Study)

  50. Additional Studies Utilizing DLW • Collaborative study (Purdue) validating dietary assessment method using the cell phone and digital imaging • Collaborative study (Pitt) validating a Unified Sensor System for Assessment of Dietary intake. • Collaborative studies with Cheyney University. • Examine EE in females entering Freshmen year

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