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1 Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin 53706-1571; 2 National Institute on Aging and 3 National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland 20892; and 4 Prevention Sciences Group, University of California, San Francisco, California 94143
Isotopic determination of total
energy expenditure (TEE) by the doubly labeled water (DLW) method may
be affected by urine retention in the elderly. The isotopic
enrichments in urine and plasma sampled simultaneously 4 h
post-DLW dose were compared in a subset of 281 subjects [139 women,
142 men, 75 ± 3 (SD) yr] of the 3,075 participants in the
Health, Aging, and Body Composition study. Based on analytic
precisions, a ±2% urine-plasma difference was set as the cut-off
value. Ten percent of the population presented a difference lower than
2%, suggesting a delay in urine isotopic equilibration. This
13 ± 10% urine-plasma difference was not linked to analytic
errors, illnesses, the sampling time, or 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 total body water and the TEE, respectively. Unexpectedly, 21% of
the population presented a urine-plasma difference higher than ±2%
that resulted, however, in a nonsignificant TEE underestimation of
3 ± 5%. In conclusion, the delayed isotopic equilibration
observed in urine reduces the accuracy of the DLW method in the
elderly. It is recommended, when blood sampling is impossible, to adopt
the intercept method with urine sampling 24 h postdose.
aging; energy requirements; deuterium; oxygen-18
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