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Isotope Dilution for Measuring Total Energy Expenditure, Water Turnover, and Total Body Water in Athletes: A Systematic Review.

Title: Isotope Dilution for Measuring Total Energy Expenditure, Water Turnover, and Total Body Water in Athletes: A Systematic Review.
Authors: Jesus, Filipe; Costello, Nessan B.; Kondo, Emi; Francisco, Rúben; Nunes, Catarina L.; Matu, Jamie; Sardinha, Luis B.; Murphy-Alford, Alexia J.; Luke, Amy H.; Pontzer, Herman; Rood, Jennifer; Sagayama, Hiroyuki; Westerterp, Klaas R.; Wong, William W.; Yamada, Yosuke; Schoeller, Dale A.; Speakman, John R.; Silva, Analiza M.
Source: International Journal of Sport Nutrition & Exercise Metabolism; Jul2025, Vol. 35 Issue 4, p363-382, 20p
Subject Terms: REFERENCE values; RESEARCH funding; SPORTS; BODY composition; CINAHL database; SEX distribution; ENDURANCE sports; INFORMATION storage & retrieval systems; DESCRIPTIVE statistics; TEAM sports; ENERGY metabolism; ATHLETES; SYSTEMATIC reviews; MEDLINE; WATER in the body; WATER; MEDICAL databases; WATER-electrolyte balance (Physiology); ISOTOPES; DOUBLY labeled water technique; ONLINE information services
Abstract: Isotope-based tracer methods allow the determination of total energy expenditure (TEE), water turnover (rH2O), and total body water (TBW) in free-living conditions. These methods have exciting applications in athletes. However, the limited number of available measurements constrains their applicability. The aim was to describe the application of isotope dilution techniques for measuring TEE, rH2O, and TBW in athletic populations. A comprehensive search (https://doi.org/10.17605/OSF.IO/7932T) was performed in three databases: PubMed, EBSCO (CINAHL, MEDLINE, and SPORTDiscus), and Cochrane Library. A total of 1,540 records were identified (564 excluded) and 174 through other sources. After excluding 53 duplicates, 1,097 articles were screened. A total of 121 studies were included, totaling 3,244 measurements from different types of sports, age range, and tier level, with 1,020 from female athletes and 139 measurements where sex was not reported. For TEE, 75 studies were included with values ranging from 1,939 to 10,070 kcal/day. For rH2O, 15 studies were included with values ranging from 2.7 to 13.4 L/day. For TBW, 77 studies were included with values ranging from 29.8 to 76.8 kg. Variability was observed across the studies among the variables of interest. Overall, males showed higher TEE, rH2O, and TBW values than females, with endurance sports showing the greatest variability in energy and water flux, and TBW values varying most in team and mixed sports. Future research should increase representation of females, athletes with disabilities, and Tier 5 "world-class" athletes to establish normative values across sports, age groups, and sex while applying standardized isotope dilution methodologies. Isotope-based tracer methods allow the determination of total energy expenditure (TEE), water turnover (rH2O), and total body water (TBW) in free-living conditions. These methods have exciting applications in athletes. However, the limited number of available measurements constrains their applicability. The aim was to describe the application of isotope dilution techniques for measuring TEE, rH2O, and TBW in athletic populations. A comprehensive search (https://doi.org/10.17605/OSF.IO/7932T) was performed in three databases: PubMed; EBSCO (CINAHL, MEDLINE, and SPORTDiscus); and Cochrane Library. A total of 1,540 records were identified (564 excluded) and 174 through other sources. After excluding 53 duplicates, 1,097 articles were screened. A total of 121 studies were included, totaling 3,244 measurements from different types of sports, age range, and tier level, with 1,020 from female athletes and 139 measurements where sex was not reported. Variability was observed across the studies among the variables of interest. For TEE, 75 studies were included with values ranging from 1,939 to 10,070 kcal/day. For rH2O, 15 studies were included with values ranging from 2.7 to 13.4 L/day. For TBW, 77 studies were included with values ranging from 29.8 to 76.8 kg. Of note, 41 studies included more than one variable of interest: (a) 28 included both TEE and TBW, (b) five included both TEE and rH2O, (c) three included both rH2O and TBW, and (d) five included TEE, rH2O, and TBW. This review explored the use of isotope dilution in assessing TEE, rH2O, and TBW in athletes. Participants were predominantly Tier 3 athletes, male, and assessed through observational designs. Overall, sex (i.e., higher values in male athletes) and sports differences (i.e., higher variability was observed for endurance sports). Standardizing isotope-dilution methodologies and expanding on existing research in female athletes, Tier 5 "world-class," and disabled athlete populations are crucial to enhance understanding in these underrepresented groups, improving the accuracy and applicability of isotope dilution in sports science. Methodological inconsistencies, particularly in tracer equilibrium and calculation methods, were noted. This systematic review primarily describes the existing methodologies and reported values but does not establish normative reference values. Future research should focus on analyzing aggregated data to establish normative TEE, rH2O, and TBW values for athletes, helping practitioners set appropriate energy, water, and body composition requirements across various sports, age groups, and sexes. [ABSTRACT FROM AUTHOR]
: Copyright of International Journal of Sport Nutrition & Exercise Metabolism is the property of Human Kinetics Publishers, Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Complementary Index