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  • Original Article
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Improving the specificity of the [13C]mixed triacylglycerol breath test by estimating carbon dioxide production from heart rate

European Journal of Clinical Nutrition volume 60, pages 1245–1252 (2006)Cite this article

Abstract

Background:

The [13C]mixed triacylglycerol (MTG) breath test is a non-invasive measure of fat digestion and can be used to assess the need for enzyme replacement therapy in children with cystic fibrosis (CF). However, it lacks specificity. Quantitation of cumulative percent dose recovered (cPDR) requires knowledge of carbon dioxide production rate (VCO2). A resting value is assumed, but children are unlikely to remain at rest during the test.

Objective:

To improve the specificity and therefore the positive predictive value (PPV) of the MTG breath test using calibrated heart rate monitors to estimate non-resting VCO2.

Design:

Proof of concept study.

Subjects:

Six children with CF, 10 healthy children and eight healthy adults performed [13C]MTG breath tests.

Methods:

Heart rate monitors were worn throughout the test. Non-resting VCO2 was estimated continuously from heart rate. Percentage dose recovered was calculated using predicted resting VCO2, measured resting VCO2 and non-resting VCO2 estimated from heart rate. Physical activity level (PAL) was taken as cPDR calculated using non-resting VCO2 divided by cPDR calculated using measured resting VCO2. The cutoff point was determined using two graph-receiver operator characteristics.

Results:

Use of calibrated heart rate monitors to estimate non-resting VCO2 improved the specificity of the test. The PPV increased from 0.67 to 0.99. PAL was 1.3 in adults and children who performed the test in hospital, and 1.7 in children who performed the test at home.

Conclusion:

Individually calibrated heart rate monitors are useful tools to estimate non-resting VCO2 during the [13C]MTG breath test.

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Acknowledgements

We acknowledge financial support from the UK Medical Research Council Joint Research Equipment Initiative and the University of Glasgow, and thank Cambridge Isotopes Laboratory Inc, Andover, MA, USA for donating the [13C]MTG used in this study. We thank Dr Simon Ling, formerly consultant gastroenterologist, Royal Hospital for Sick Children (RHSC), Glasgow, for assistance in recruiting children with CF.

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Authors and Affiliations

  1. Division of Developmental Medicine, University of Glasgow, Yorkhill Hospitals, Glasgow, UK

    C Slater & L T Weaver

  2. Stable Isotope Biochemistry Laboratory, Scottish Universities Environmental Research Centre, East Kilbride, Glasgow, UK

    T Preston

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  1. C Slater
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  2. T Preston
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  3. L T Weaver
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Correspondence to C Slater.

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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. Improving the specificity of the [13C]mixed triacylglycerol breath test by estimating carbon dioxide production from heart rate. Eur J Clin Nutr 60, 1245–1252 (2006). https://doi.org/10.1038/sj.ejcn.1602444

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