Stable Isotope Techniques to Develop and Monitor Nutrition Interventions

Abstract

A combination of industrialization, urbanization, economic development and globalization has resulted in rapid changes in diets and lifestyles for many populations. The impact of these changes is significant for the health and nutritional status of such populations, particularly in the developing world. The negative consequences of the nutrition transition include poor nutrition and decreased physical activity, with a corresponding increase in diet-related chronic diseases such as obesity, diabetes mellitus, cardiovascular disease, hypertension, stroke, osteoporosis and some cancers, particularly among the poor. The coexistence of chronic diseases and undernutrition of infants, children and women, and overnutrition in adults, has been referred to as the double burden of malnutrition.Stable isotope techniques are now in widespread use in applied nutrition, however, in this paper we discuss three of the techniques with particular relevance to the development and monitoring of nutrition interventions globally. These techniques include the doubly labelled water (DLW) technique of deuterium ( 2 H) and oxygen-18 ( 18 O) to assess total energy expenditure (TEE), the use of 2 H to estimate total body water (TBW) and assessment of body composition as well as the deuterium oxide 'dose-to-mother' technique to assess human milk intake in breastfed infants.

Body mass index vs deuterium dilution method for establishing childhood obesity prevalence, Ghana, Kenya, Mauritius, Morocco, Namibia, Senegal, Tunisia and United Republic of Tanzania

“…BMI: body mass index. a We measured height and weight and calculated obesity from BMI-for-age using the World Health Organization reference z-score > +2.00 standard deviations. b We measured body fatness using the deuterium dilution method and defined excessive body fat percentage as > 25% in boys and > 30% in girls 11 , 12 …”

“…b We measured body fatness using the deuterium dilution method and defined excessive body fat percentage as > 25% in boys and > 30% in girls 11 , 12 …”

“…We aimed to measure total body water in all participants using the deuterium dilution method, as described previously 11 , 14 . We used standard operating procedures, with training support provided for all countries via a combination of residential and on-site training by experts recruited by the International Atomic Energy Agency.…”

“…However, such methods are laboratory-based and impractical for large-scale epidemiological studies. While not a criterion method, body fatness measured by total body water is practical for large epidemiological studies and provides accurate measures of fatness which are unbiased relative to multicomponent methods 11 , 12 …”

“…First, few studies tested the diagnostic performance of the WHO BMI-for-age definition of obesity, focusing on definitions based on national BMI reference data or the International Obesity Task Force definition 9 , 10 . Second, few studies assessed the diagnostic performance of BMI-for-age against a measure of body fatness with low bias and acceptable individual diagnostic accuracy such as total body water 11 , 12 . Finally, the applicability of the evidence to African children is unclear; bias in the estimation of excessive body fatness by BMI varies across populations in adults 13 .…”