Precision and accuracy of doubly labeled water energy expenditure by multipoint and two-point methods

Two-point or multipoint, that is the question. Equations are developed to compare the precision and accuracy of energy expenditure, as estimated from doubly labeled water data, when analyzed by the multipoint and two-point methods. The equations convert the enrichments of deuterium and oxygen-18 into their ratio and product, quantities that are less covariant than the two isotopes themselves are. This is important not only for estimating the precision but also as a graphical aid, since the ratios of the enrichments model carbon dioxide production, whereas the enrichment products largely model water turnover. Using data on 12 human subjects from the United Kingdom and The Gambia as examples, the combined precision and accuracy of the multipoint method (CV 3.6%) was found to be appreciably better than the two-point method (CV 5.4%). The bias in the multipoint estimate of body pool size would need to be three times as large as was observed before it canceled out the better precision.