An objective estimate of energy intake during weight gain using the intake-balance method

Background: Estimates of energy intake (EI) in humans have limited validity. Objective: The objective was to test the accuracy and precision of the intake-balance method to estimate EI during weight gain induced by overfeeding. Design: In 2 studies of controlled overfeeding (1 inpatient study and 1 outpatient study), baseline energy requirements were determined by a doubly labeled water study and caloric titration to weight maintenance. Overfeeding was prescribed as 140% of baseline energy requirements for 56 d. Changes in weight, fat mass (FM), and fat-free mass (FFM) were used to estimate change in energy stores (ΔES). Overfeeding EI was estimated as the sum of baseline energy requirements, thermic effect of food, and ΔES. The estimated overfeeding EI was then compared with the actual EI consumed in the metabolic chamber during the last week of overfeeding. Results: In inpatient individuals, calculated EI during overfeeding determined from ΔES in FM and FFM was (mean ± SD) 3461 ± 848 kcal/d, which was not significantly (-29 ± 273 kcal/d or 0.8%; limits of agreement: -564, 505 kcal/d; P = 0.78) different from the actual EI provided (3490 ± 729 kcal/d). Estimated EI determined from ΔES in weight closely estimated actual intake (-7 ± 193 kcal/d or 0.2%; limits of agreement: -386, 370 kcal/d; P = 0.9). In free-living individuals, estimated EI during overfeeding determined from ΔES in FM and FFM was 4123 ± 500 kcal/d and underestimated actual EI (4286 ± 488 kcal/d; -162 ± 301 kcal or 3.8%; limits of agreement: -751, 427 kcal/d; P = 0.003). Estimated EI determined from ΔES in weight also underestimated actual intake (-159 ± 270 kcal/d or 3.7%; limits of agreement: -688, 370 kcal/d; P = 0.001). Conclusion: The intake-balance method can be used to estimate EI during a period of weight gain as a result of 40% overfeeding in individuals who are inpatients or free-living with only a slight underestimate of actual EI by 0.2-3.8%. This trial was registered at clinicaltrials.gov as NCT00565149 and NCT01672632.