Improving the specificity of the [(13)C]mixed triacylglycerol breath test by estimating carbon dioxide production from heart rate.
Background:The [(13)C]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 (VCO(2)). 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 VCO(2).Design:Proof of concept study.Subjects:Six children with CF, 10 healthy children and eight healthy adults performed [(13)C]MTG breath tests.Methods:Heart rate monitors were worn throughout the test. Non-resting VCO(2) was estimated continuously from heart rate. Percentage dose recovered was calculated using predicted resting VCO(2), measured resting VCO(2) and non-resting VCO(2) estimated from heart rate. Physical activity level (PAL) was taken as cPDR calculated using non-resting VCO(2) divided by cPDR calculated using measured resting VCO(2). The cutoff point was determined using two graph-receiver operator characteristics.Results:Use of calibrated heart rate monitors to estimate non-resting VCO(2) 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 VCO(2) during the [(13)C]MTG breath test.European Journal of Clinical Nutrition (2006) 60, 1245-1252. doi:10.1038/sj.ejcn.1602444; published online 31 May 2006.[1]References
- Improving the specificity of the [(13)C]mixed triacylglycerol breath test by estimating carbon dioxide production from heart rate. Slater, C., Preston, T., Weaver, L.T. European journal of clinical nutrition. (2006) [Pubmed]
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