A prospective randomised study comparing oral 13C-bicarbonate tracer technique versus indirect calorimetry for measurement of energy expenditure in adults.

BACKGROUND AND AIMS: Accurate assessment of energy expenditure (EE) is important in guiding nutritional therapy but current methods are unsatisfactory. This study compared the oral 13C-bicarbonate tracer (BT) technique using the IRIS® system (Wagner, Germany) against indirect calorimetry (IC, ventilated-hood) to measure CO2 output (VCO2) and thus estimate EE. METHODS: Ten overnight-fasted healthy male volunteers were randomised to studies at rest or mild exercise in a crossover manner. During each study BT-IRIS® and IC were used simultaneously to measure VCO2 and thus EE. Participants ingested a drink labelled with 50mg 13C-bicarbonate and breath samples were collected every 5 min for 180 min and analysed using IRIS®. Bland-Altman plots were used to assess agreement between the two techniques in measurements of VCO2 (L/day) and estimates of EE (kJ/day). RESULTS: Mean ± SE age and BMI of participants were 21.1 ± 1.1 yrs and 23.6 ± 0.6 kg/m2. Both at rest and exercise, there was small bias but overall poor agreement between the two techniques as evident by the wide 95% limits of agreement in measurements of VCO2 and EE: rest VCO2 (bias 1.4, SD 93, 95% limits of agreement -180 to 183), rest EE (-8.3, 1830, -3595 to 3578), exercise VCO2 (49.3, 66.1, -80.4 to 178.9) and exercise EE (1083, 1944, -2727 to 4893). Furthermore, there was also evidence of systematic error in these measurements. CONCLUSION: Prior to clinical application, further optimisation of the BT-IRIS® system should be undertaken, given the poor agreement with IC in measuring VCO2 and estimating EE.