Abstract
Background:
13C-breath tests are noninvasive tools to measure gastrointestinal function and nutritional interventions. Calculation of percentage dose recovered of 13C in exhaled breath requires knowledge of CO2 production rate (VCO2). A resting value is usually assumed, but this can underestimate VCO2 because subjects are unlikely to remain at rest during tests that last for many hours. There is a need for a method to estimate nonresting VCO2 during 13C-breath tests.
Objective:
To calibrate a heart rate monitor to continually estimate VCO2 during 13C-breath tests.
Design:
Proof of concept study.
Subjects:
Eight healthy adults, 10 healthy children and six children with cystic fibrosis.
Methods:
Heart rate and VCO2 were measured simultaneously at resting and nonresting levels. A new calibration method (smoothing heart rate and fitting a sigmoid function) was compared with published methods. A [13C]acetate breath test was used to demonstrate the range of physical activity during breath tests.
Results:
The new calibration method was more accurate than existing methods (mean bias −0.0002%, 95% confidence interval (CI) −0.0007, 0.0003% of the mean measured VCO2). Smoothing heart rate gave a more precise estimate of VCO2 and a more accurate estimate of resting energy expenditure (mean bias −0.09, 95% CI −0.22, 0.05 mmol CO2 min−1 m−2 body surface area) than using raw data (mean bias −0.21, 95% CI −0.38, −0.04 mmol CO2 min−1 m−2 body surface area). Physical activity level ranged from 1.0 to 2.5 in children, and 1.0 to 1.5 in adults.
Conclusion:
Use of smoothed HR with a sigmoid function provides an accurate method of estimating nonresting VCO2 during 13C-breath tests.
Sponsorship:
The work described in this paper was funded by the University of Glasgow and UK Medical Research Council Joint Research Equipment Initiative.
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References
Amarri S, Coward WA, Harding M, Weaver LT (1998). Importance of measuring CO2-production rate when using 13C-breath tests to measure fat digestion. Br J Nutr 79, 541–545.
Amarri S, Harding M, Coward WA, Evans TJ, Weaver LT (1997). 13Carbon mixed triglyceride breath test and pancreatic enzyme supplementation in cystic fibrosis. Arch Dis Child 76, 349–351.
Amarri S, Weaver LT (1995). 13C-breath tests to measure fat and carbohydrate digestion in clinical practice. Clin Nutr 14, 149–154.
Beghin L, Budniok T, Vaksman G, Boussard-Delbecque L, Michaud L, Turck D et al. (2000). Simplification of the method of assessing daily and nightly energy expenditure in children, using heart rate monitoring calibrated against open circuit indirect calorimetry. Clin Nutr 19, 425–435.
Beghin L, Michaud L, Guimber D, Vaksmann G, Turck D, Gottrand F (2002). Assessing sleeping energy expenditure in children using heart-rate monitoring calibrated against open-circuit indirect calorimetry: a pilot study. Br J Nutr 88, 533–543.
Bitar A, Vermorel M, Fellmann N, Bedu M, Chamoux A, Coudert J (1996). Heart-rate recording method validated by whole-body indirect calorimetry in 10-year-old children. J Appl Physiol 81, 1169–1173.
Christian MT, Amarri S, Franchini F, Preston T, Morrison DJ, Dodson B et al. (2002). Modeling 13C-breath curves to determine site and extent of starch digestion and fermentation in infants. J Pediatr Gastroenterol Nutr 34, 158–164.
Cole TJ, Freeman JV, Preece MA (1995). Body mass index reference curves for the UK, 1990. Arch Dis Child 73, 25–29.
Dauncey MJ, James WPT (1979). Assessment of the heart-rate method for determining energy expenditure in man, using a whole body calorimeter. Br J Nutr 42, 1–13.
Davidson L, McNeill G, Haggarty P, Smith JS, Franklin MF (1997). Free-living energy expenditure of adult men assessed by continuous heart-rate monitoring and doubly-labelled water. Br J Nutr 78, 695–708.
Department of Health (1991). Dietary Reference Values for Food Energy and Nutrients for the United Kingdom Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. HMSO: London.
Ghoos YF, Vantrappen G, Rutgeerts PJ, Schurmans PC (1981). A mixed-triglyceride breath test for intraluminal fat digestive activity. Digestion 22, 239–247.
Haycock G, Schwartz G, Wisotsky G (1978). Geometric method for measuring body surface area: a height-weight formula validated in infants, children and adults. J Pediatr 93, 62–66.
IDECG (1990). The Doubly-labelled Water Method for Measuring Energy Expenditure: Technical recommendations for use in humans. IAEA: Vienna.
Li R, Deurenberg P, Huatvast JGAJ (1993). A critical evaluation of heart rate monitoring to assess energy expenditure in individuals. Am J Clin Nutr 58, 602–607.
Ling SC, Amarri S, Slater C, Hollman AS, Preston T, Weaver LT (2000). Liver disease does not affect lipolysis as measured with the 13C-mixed triacylglycerol breath test in children with cystic fibrosis. J Pediatr Gastroenterol Nutr 30, 368–372.
Livingstone MBE, Coward WA, Prentice AM, Davies PSW, Strain JJ, McKenna PG et al. (1992). Daily energy expenditure in free-living children: comparison of heart-rate monitoring with doubly labeled water (2H218O) method. Am J Clin Nutr 56, 243–352.
Montgomery C, Reilly JJ, Jackson DM, Kelly LA, Slater C, Paton JY et al. (2004). Relation between physical activity and energy expenditure in a representative sample of young children. Am J Clin Nutr 80, 591–596.
Moon JK, Butte NF (1996). Combined heart rate and activity improve estimates of oxygen consumption and carbon dioxide production rates. J Appl Physiol 81, 1754–1761.
Morrison DJ, Dodson B, Slater C, Preston T (2000). 13C natural abundance in the British diet: implications for 13C breath tests. Rapid Commun Mass Spectrom 14, 1321–1324.
Morrison DJ, Preston T, Dodson B, Weaver LT (2003). Gastrointestinal handling of glycosyl [13C]ureides. Eur J Clin Nutr 57, 1017–1024.
Motulsky HJ, Ransnas LA (1987). Fitting curves to data using nonlinear regression: a practical and nonmathematical review. FASEB J 1, 365–374.
Parker AC, Preston T, Heaf D, Kitteringham NR, Choonara I (1994). Inhibition of caffeine metabolism by ciprofloxacin in children with cystic fibrosis as measured by the caffeine breath test. Br J Clin Pharmacol 38, 573–576.
Parker AC, Pritchard P, Preston T, Dalzell AM, Choonara I (1997a). Lack of inhibitory effect of cimetidine on caffeine metabolism in children using the caffeine breath test. Br J Clin Pharmacol 45, 467–470.
Parker AC, Pritchard P, Preston T, Smyth RL, Choonara I (1997b). Enhanced drug metabolism in young children with cystic fibrosis. Arch Dis Child 77, 239–241.
Rennie K, Rowsell T, Jebb SA, Holburn D, Wareham NJ (2000). A combined heart rate and movement sensor: proof of concept and preliminary testing study. Eur J Clin Nutr 54, 409–414.
Ribeyre J, Fellmann N, Vernet J, Delaître M, Chamoux A, Coudert J et al. (2000). Components and variations in daily energy expenditure of athletic and non-athletic adolescents in free-living conditions. Br J Nutr 84, 531–539.
Schofield WN (1985). Predicting basal metabolic rate, new standards and review of previous work. Human Nutr: Clin Nutr 39C, 5–41.
Schulz S, Westerterp KR, Bruck K (1989). Comparison of energy expenditure by the doubly labeled water technique with energy intake, heart rate, and activity recording in man. Am J Clin Nutr 49, 1146–1154.
Shreeve VW, Cerasi E, Luft R (1970). Metabolism of [2-14C]pyruvate in normal, acromegalic and HGH-treated human subjects. Acta Endocrinol 65, 155–169.
Slater C (2004). Improvements to the [13C]MTG breath test for measuring fat digestion PhD thesis, University of Glasgow, 162.
Slater C, Ling SC, Preston T, Weaver LT (2002a). Analysis of 13C-mixed triacylglycerol in stool by bulk (EA-IRMS) and compound specific (GC-MS) methods. Isotopes Environ Health Stud 38, 79–86.
Slater C, Preston T, Morrison DJ, Weaver LT (2002b). A shelf-stable, platable test meal suitable for use with hydrophilic and lipophilic tracers in 13C breath tests. Proc Nutr Soc 61, 66A (abstract).
Slater C, Preston T, Weaver LT (2003). Use of calibrated heart rate monitors to estimate CO2 production rate during the 13C-mixed triacyglycerol (MTG) breath test. Proc Nutr Soc 62, 9A (abstract).
Slater C, Preston T, Weaver LT (2004). Is there an advantage in normalising the results of the Helicobacter pylori [13C]urea breath test for CO2 production rate in children? Isotopes Environ Health Stud 40, 89–98.
Spurr GB, Prentice AM, Murgatroyd PR, Goldberg GR, Reina JC, Christman NT (1988). Energy expenditure from minute-by-minute heart-rate recording: comparison with indirect calorimetry. Am J Clin Nutr 48, 552–559.
Strath SJ, Bassett Jr DR, Thompson DL, Swartz AM (2002). Validity of the simultaneous heart-rate motion sensor technique for measuring energy expenditure. Med Sci Sports Exerc 34, 888–894.
Sutton DGM, Bahr A, Preston T, Christley RM, Love S, Roussel AJ (2003). Validation of the C-13-octanoic acid breath test for measurement of equine gastric emptying rate of solids using radioscintigraphy. Equine Vet J 35, 27–33.
Sutton DGM, Preston T, Christley RM, Cohen ND, Love S, Roussel AJ (2002). The effects of xylazine, detomidine, acepromazine and butorphanol on equine solid phase gastric emptying rate. Equine Vet J 34, 486–492.
Vantrappen GR, Rutgeerts PJ, Ghoos YF, Hiele MI (1989). Mixed triglyceride breath test: a noninvasive test of pancreatic lipase activity in the duodenum. Gastroenterology 96, 1126–1134.
Vermorel M, Vernet J, Bitar A, Fellmann N, Coudert J (2002). Daily energy expenditure, activity patterns, and energy costs of the various activities in French 12-16-y-old adolescents in free living conditions. Eur J Clin Nutr 56, 819–829.
Walsh S, Diamond D (1995). Non-linear curve fitting using Microsoft Excel Solver. Talanta 42, 561–572.
Wyse CA, Murphy DM, Preston T, Sutton DG, Morrison DJ, Christley RM et al. (2001a). The 13C-octanoic acid breath test for detection of effects of meal composition on the rate of solid-phase gastric emptying in ponies. Res Vet Sci 71, 81–83.
Wyse CA, Preston T, Love S, Morrison DJ, Cooper JM, Yam PS (2001b). Use of the 13C-octanoic acid breath test for assessment of solid-phase gastric emptying in dogs. Am J Vet Res 62, 1939–1944.
Acknowledgements
We acknowledge financial support from the UK Medical Research Council Joint Research Equipment Initiative and the University of Glasgow and thank Dr Simon Ling, formerly consultant gastroenterologist, Royal Hospital for Sick Children, Glasgow for assistance in recruiting children with cystic fibrosis.
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Guarantor: C Slater.
Contributors: CS performed the study, analysed the data, wrote the first draft and refined the manuscript. TP conceived the original idea, advised on study design and data analysis and critically appraised the manuscript. LTW cosupervised the project, and critically appraised the manuscript.
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Slater, C., Preston, T. & Weaver, L. Comparison of accuracy and precision of heart rate calibration methods to estimate total carbon dioxide production during 13C-breath tests. Eur J Clin Nutr 60, 69–76 (2006). https://doi.org/10.1038/sj.ejcn.1602269
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DOI: https://doi.org/10.1038/sj.ejcn.1602269
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