An objective measure of energy intake using the principle of energy balance

Abstract

Background The measurement of energy intake is central to the understanding of energy balance and predicting changes in body weight. Until recently, the most commonly used methods of assessing intake were self-reported diet recalls, diet diaries, or food-frequency questionnaires. These methods, however, are subject to systematic biases and are often inaccurate. Aim Review the validations and applications of an expenditure/balance method for measuring energy intake. Methods Review the literature regarding the theory and practice of objectively measuring energy intake based on the principle of energy balance i.e., energy intake is calculated from the measured total energy expenditure plus the change in body energy stores (ES). The attainable precision is modeled and compared with the accuracy and precision of validations against known energy intake. Results Measurement of energy intake, calculated in this way, is accurate to within 2% and has a precision of 4–37% depending on the expenditure and body composition methods used and the time interval between measures. Applications of this expenditure/balance (EB) method have provided novel data on the compliance to dietary restriction and its association with physical activity interventions, and the effects of bariatric surgery on energy intake and weight gain. Practical limitations to this method, however, include cost and limited access to the analyses required by the DLW method. Conclusion The EB method of objectively measuring energy intake is objective, accurate, and reasonably precise. It is practical for moderate-sized studies.