The use of doubly-labeled water to assess free-living energy expenditure is currently regarded as the gold standard technique. With a reported precision of ± 3%, this method serves as a reference for validating other instruments or methods designed to measure energy expenditure.
Doubly-labeled water is a noninvasive procedure involving the ingestion of a quantity of water labeled with a known concentration of naturally occurring, stable isotopes of hydrogen and oxygen. As energy is expended in the body, carbon dioxide and water are produced, and the differences between the isotope elimination rates are used to calculate total energy expenditure. This method can be carried out on a wide range of individuals over lengthy time periods, usually between 4 and 21 days, which is advantageous for capturing habitual energy expenditure patterns. However, the cost of materials and expertise required to analyze the isotope concentrations via mass spectrometry prohibits the use of doubly-labeled water in large epidemiological studies.
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