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Articles in PresS, published online ahead of print November 2, 2001
J Appl Physiol, 10.1152/jap.00743.2001
Submitted on July 16, 2001
Accepted on October 28, 2001
1 Nutritional Sciences, University of Wisconsin, Madison, WI, USA
2 National Institute of Aging, Bethesda, ML, USA
3 National institute of diabetes and digestive and kidney diseases, Bethesda, ML, USA
* To whom correspondence should be addressed. E-mail: blanc{at}nutrisci.wisc.edu.
In the elderly, the isotopic determination of the total energy expenditure (EE) by the doubly labeled water (DLW) method may be affected by urine retention that is prevalent in this population. Since DLW measurements usually rely on spot urine samples, urine retention may delay the equilibration of isotopes and bias the EE estimates. To test this hypothesis, the isotopic enrichments in urine and plasma sampled simultaneously 4-hours post-DLW dose were compared in a subset of 281 subjects (139 women: 75 ± 3 years and 142 men: 75 ± 3 years) of the 3075 participants of the Health, Aging and Body Composition study. Based on analytical precisions, a urine-plasma difference ± 2% was set as cut-off value. We observed that 10% of the population present a difference lower than -2%, suggesting a delay in urine equilibration of isotopes compared to plasma. This -13±10% (means±SD) urine-plasma difference was not linked to analytical errors, illnesses, the sampling time, nor to the time and quantity of water intake; suggesting that urine retention may be the main factor. The consequences are an 18±13 and 21±16% overestimation of the TBW and the EE, respectively. Unexpectedly 21% of the population presented a urine-plasma difference higher than the cut-off value of ±2% that, however, resulted in a non-significant underestimation of -3±5% of the TEE. In conclusion, the delayed isotopic equilibration observed in urine reduces the accuracy of the DLW method in the elderly and has to be considered, especially because the reported prevalence of isotope derived-urine retention is in the lower range of the literature. It is recommended, when blood sampling is impossible, to adopt the intercept method with urine sampling 24 hours post-dose.
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