Total Energy Expenditure in Healthy Chinese Populations: A Nationwide Study Using the Doubly Labelled Water Method
1 other identifier
observational
240
1 country
7
Brief Summary
Between 1990 and 2022, the global prevalence of obesity more than doubled, representing a critical public health concern. China has mirrored this trend, with rapidly increasing rates of overweight and obesity across all age groups. According to the 'Report on Chinese Residents' Nutrition and Chronic Diseases (2020)', 50.7% of Chinese adults are now classified as overweight or obese. Among children and adolescents aged 6 to 17 years, data from the 'Atlas of Nutrition and Health Status of Chinese Children' indicates that the prevalence of overweight and obesity has reached 26.5%. Obesity is associated with a broad spectrum of adverse health outcomes across the life course. In children, excess adiposity negatively affects skeletal maturation, neurocognitive development, and psychosocial well-being, while also increasing the likelihood of obesity and metabolic dysfunction in adulthood. In adults, obesity is a major risk factor for a range of non-communicable diseases (NCDs), including type 2 diabetes mellitus, hypertension, cardiovascular disease, non-alcoholic fatty liver disease, osteoarthritis, certain cancers, and all-cause premature mortality. Beyond its health implications, obesity imposes substantial economic and social burdens, including increased healthcare expenditure and reduced workforce productivity. The etiology of the obesity epidemic is multifactorial and remains under active investigation. Hypotheses center around a chronic imbalance between energy intake and expenditure, driven by behavioral, environmental, and physiological factors. Notably, decreased physical activity associated with sedentary lifestyles and increased consumption of energy-dense, nutrient-poor foods have been implicated as key contributors. However, the relative contributions of reduced energy expenditure versus increased energy intake remain insufficiently quantified at the population level. Accurate assessment of total energy expenditure (TEE) is therefore essential to elucidate the energy dynamics underlying the obesity epidemic. Current approaches for estimating population-level energy and food requirements are often based on indirect methods with limited precision. The doubly labelled water (DLW) technique, which quantifies TEE through measurement of isotope elimination rates (\^2H and \^18O), remains the gold standard for assessing free-living energy expenditure. However, its application has been predominantly confined to high-income countries with well-established research infrastructure. In contrast, the use of DLW in low- and middle-income countries-including China-remains minimal, resulting in critical data gaps that hinder the development of context-specific dietary recommendations and energy requirement models. To address these limitations, this study will apply the DLW method to measure TEE in healthy children and adults in China. In parallel, the study will assess key modulators of energy metabolism, including anthropometric and physiological parameters, gut microbiota composition, habitual physical activity, and ambient temperature exposure. The resulting dataset will provide high-resolution, population-specific evidence to inform national dietary reference intakes and support the formulation of evidence-based public health strategies aimed at obesity prevention and metabolic health promotion.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for all trials
Started Jul 2025
7 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
July 1, 2025
CompletedFirst Submitted
Initial submission to the registry
August 25, 2025
CompletedFirst Posted
Study publicly available on registry
September 17, 2025
CompletedPrimary Completion
Last participant's last visit for primary outcome
July 1, 2027
ExpectedStudy Completion
Last participant's last visit for all outcomes
July 1, 2027
September 17, 2025
September 1, 2025
2 years
August 25, 2025
September 16, 2025
Conditions
Outcome Measures
Primary Outcomes (43)
Height
Height in meters will be measured by Leicester stadiometer (Seca 217, Germany) and reported to two decimal places.
About 3 minutes.
Weight
Weight in kilograms will be measured by TANITA.
About 5 minutes.
BMI
BMI values in kg/m2 will be calculated from weight measured by TANITA and height measured by Leicester stadiometer (Seca 217, Germany).
About 10 minutes (calculated)
Fat mass
Fat mass in kilograms will be measured by TANITA.
About 3 minutes.
Fat percentage
Fat percentage will be measured by TANITA.
About 3 minutes.
Fat-free mass
Fat-free mass in kilograms will be measured by TANITA.
About 3 minutes.
Muscle mass
Muscle mass in kilograms will be measured by TANITA.
About 3 minutes.
Total body water
Total body water in kilograms will be measured by TANITA.
About 3 minutes.
Waist circumference
Waist circumference(measured in centimeters) will be obtained using a flexible tape measure following standardized protocols.
About 5 minutes.
Hip circumference
Hip circumference(measured in centimeters) will be obtained using a flexible tape measure following standardized protocols.
About 5 minutes.
Thigh circumference
Thigh circumference(measured in centimeters) will be obtained using a flexible tape measure following standardized protocols.
About 5 minutes.
Neck circumference
Neck circumference(measured in centimeters) will be obtained using a flexible tape measure following standardized protocols.
About 5 minutes.
Blood pressure
Blood pressure will be measured using a standardized blood pressure monitor, with recordings of both systolic and diastolic values.
About 10 minutes.
Heart rate
Heart rate will be measured in using a standardized blood pressure monitor.
About 10 minutes.
Abdominal fat
Abdominal fat will be measured in using a portable ultrasound device (DW-360).
About 20 minutes.
Bone mineral density
Bone mineral density will be measured using the Dual-energy X-ray Absorptiometry (DXA) device.
About 20 minutes.
Mid-upper arm circumference
Mid-upper arm circumference (measured in centimeters) will be obtained using a flexible tape measure following standardized protocols.
About 5 minutes.
Grip strength
Grip strength will be obtained using a dynamometer(CAMRY, EH101).
About 5 minutes.
Skin carotenoid concentration
Skin carotenoid concentration will be measured in using the Veggie Meter，and the results will be expressed as Standard Point Score (SPS), typically ranging from 0 to 800 SPS. Higher SPS values indicate higher skin carotenoid concentration.
About 5 minutes.
Red Blood Cell Count
Red blood cell count will be measured in fasting blood samples.
About 10 minutes.
White Blood Cell Count
White blood cell count will be measured in fasting blood samples.
About 10 minutes.
Hemoglobin
Hemoglobin concentration will be measured in fasting blood samples, reported in grams per liter (g/L).
About 10 minutes.
Total Cholesterol
Total cholesterol concentration will be measured in fasting blood samples, reported in millimoles per liter (mmol/L).
About 10 minutes.
Triglycerides
Triglycerides concentration will be measured in fasting blood samples, reported in millimoles per liter (mmol/L).
About 10 minutes.
High-Density Lipoprotein Cholesterol
High-density lipoprotein cholesterol (HDL-C) concentration will be measured in fasting blood samples, reported in millimoles per liter (mmol/L).
About 10 minutes.
Low-Density Lipoprotein Cholesterol
Low-density lipoprotein cholesterol (LDL-C) concentration will be measured in fasting blood samples, reported in millimoles per liter (mmol/L).
About 10 minutes.
Alanine Aminotransferase
Alanine aminotransferase (ALT) activity will be measured in fasting blood samples, reported in units per liter (U/L).
About 10 minutes.
Aspartate Aminotransferase
Aspartate aminotransferase (AST) activity will be measured in fasting blood samples, reported in units per liter (U/L).
About 10 minutes.
Total Bilirubin
Total bilirubin concentration will be measured in fasting blood samples, reported in micromoles per liter (μmol/L).
About 10 minutes.
Direct Bilirubin
Direct bilirubin concentration will be measured in fasting blood samples, reported in micromoles per liter (μmol/L).
About 10 minutes.
Indirect Bilirubin
Indirect bilirubin concentration will be measured in fasting blood samples, reported in micromoles per liter (μmol/L).
About 10 minutes.
Blood Urea Nitrogen
Blood urea nitrogen (BUN) concentration will be measured in fasting blood samples, reported in millimoles per liter (mmol/L).
About 10 minutes.
Serum Uric Acid
Serum uric acid concentration will be measured in fasting blood samples, reported in micromoles per liter (μmol/L).
About 10 minutes.
Serum Creatinine
Serum creatinine concentration will be measured in fasting blood samples, reported in micromoles per liter (μmol/L).
About 10 minutes.
Vitamin D levels
Vitamin D levels will be obtained by collecting blood samples.
About 10 minutes.
Gut microbiota
Gut microbiota will be obtained by collecting fecal samples.
About 10 minutes.
Secondary sexual characteristics
The Tanner stages are used to assess the development of secondary sexual characteristics and are divided into five stages. For boys, the evaluation includes pubic hair development and genital development (including testicular and penile growth). For girls, the evaluation includes pubic hair development and breast development (thelarche).
About 5 minutes.
Basal metabolic rate
The basal metabolic rate in kcal or MJ will be measured by respiratory indirect calorimetry (Cosmed).
About 30 minutes.
Total energy expenditure
Total energy expenditure in kcal or MJ will be measured using the DLW method. TEE will then be calculated using mean CO2 production using the Weir equation.
About 14 days.
Environmental temperature
The iButton (DS1921G) monitors will be provided for the assessment of both indoor and outdoor temperature of their living environment, measured in degrees Celsius (°C).
About 14 days.
Physical activity energy expenditure
Physical activity energy expenditure will be recorded using a GT3X accelerometer worn at the waist for a consecutive period of 14 days, with results expressed in kilocalories (kcal) or megajoules (MJ) per day.
About 14 days.
Total moderate-to-vigorous physical activity (MVPA)
Total MVPA will be recorded using a GT3X accelerometer worn at the waist for a consecutive period of 14 days, with results expressed in minutes per day (min/day).
About 14 days.
Vector magnitude counts
Vector magnitude counts will be recorded using a GT3X accelerometer worn at the waist for a consecutive period of 14 days, with results expressed as counts per minute (cpm). Higher cpm values indicate greater overall physical activity intensity, reflecting the average level of movement during the monitoring period.
About 14 days.
Eligibility Criteria
The research participants will consist of healthy adults aged 30 to 60 and healthy children aged 7 to 18 years who exhibit normal growth and development. All participants are neither overweight nor obese, nor will they have any nutritional deficiencies. They will be capable of cooperating to complete all necessary measurements. None of these participants has been diagnosed with chronic diseases, musculoskeletal injuries or disabilities. Moreover, all participants will be free from acute clinical diseases at least seven days prior to the study.
You may qualify if:
- Healthy participants
You may not qualify if:
- Malnutrient as defined by the Chinese national standards WS/T456-2014 and WS/T 586-2018
- Nutritional deficiencies
- Overweight
- Obesity
- Acute illness within the past 7 days
- Fever
- Diarrhea
- Vomiting
- Chronic diseases
- Cardiovascular diseases
- Diabetes mellitus or any form of metabolic disorders
- Type 1 or Type 2 diabetes
- Metabolic syndrome
- Hyperlipidemia
- Dyslipidemia
- +5 more criteria
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (7)
The First Affiliated Hospital of Chongqing Medical University
Chongqing, Chongqing Municipality, 400016, China
Shenzhen Institutes of Advanced Technology,Chinese Academy of Sciences
Shenzhen, Guangdong, 518055, China
The First Affiliated Hospital of Hainan Medical University
Haikou, Hainan, 570102, China
The Affiliated Hospital of Inner Mongolia Medical University
Hohhot, Inner Mongolia, 010050, China
The Fourth Affiliated Hospital of China Medical University
Shenyang, Liaoning, 110032, China
Qingdao Center Hospital of Rehabilitation University
Qingdao, Shandong, 266042, China
Tacheng Prefecture People's Hospital
Tacheng, Xinjiang, 834700, China
Related Publications (2)
Speakman JR, Yamada Y, Sagayama H, Berman ESF, Ainslie PN, Andersen LF, Anderson LJ, Arab L, Baddou I, Bedu-Addo K, Blaak EE, Blanc S, Bonomi AG, Bouten CVC, Bovet P, Buchowski MS, Butte NF, Camps SGJA, Close GL, Cooper JA, Creasy SA, Das SK, Cooper R, Dugas LR, Ebbeling CB, Ekelund U, Entringer S, Forrester T, Fudge BW, Goris AH, Gurven M, Hambly C, El Hamdouchi A, Hoos MB, Hu S, Joonas N, Joosen AM, Katzmarzyk P, Kempen KP, Kimura M, Kraus WE, Kushner RF, Lambert EV, Leonard WR, Lessan N, Ludwig DS, Martin CK, Medin AC, Meijer EP, Morehen JC, Morton JP, Neuhouser ML, Nicklas TA, Ojiambo RM, Pietilainen KH, Pitsiladis YP, Plange-Rhule J, Plasqui G, Prentice RL, Rabinovich RA, Racette SB, Raichlen DA, Ravussin E, Reynolds RM, Roberts SB, Schuit AJ, Sjodin AM, Stice E, Urlacher SS, Valenti G, Van Etten LM, Van Mil EA, Wells JCK, Wilson G, Wood BM, Yanovski J, Yoshida T, Zhang X, Murphy-Alford AJ, Loechl CU, Melanson EL, Luke AH, Pontzer H, Rood J, Schoeller DA, Westerterp KR, Wong WW; IAEA DLW database group. A standard calculation methodology for human doubly labeled water studies. Cell Rep Med. 2021 Feb 16;2(2):100203. doi: 10.1016/j.xcrm.2021.100203. eCollection 2021 Feb 16.
PMID: 33665639BACKGROUNDWEIR JB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol. 1949 Aug;109(1-2):1-9. doi: 10.1113/jphysiol.1949.sp004363. No abstract available.
PMID: 15394301BACKGROUND
Biospecimen
Urine samples will be collected from children and adults over a 14-day period following the administration of doubly labelled water (DLW). The analysis of oxygen-18 and deuterium in these urine samples will be used to calculate the total energy expenditure of the children and the adults.
Study Officials
- PRINCIPAL INVESTIGATOR
Xueying Zhang, PhD
Shenzhen Institutes of Advanced Technology ,Chinese Academy of Sciences
Central Study Contacts
Study Design
- Study Type
- observational
- Observational Model
- COHORT
- Time Perspective
- CROSS SECTIONAL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Associate researcher
Study Record Dates
First Submitted
August 25, 2025
First Posted
September 17, 2025
Study Start
July 1, 2025
Primary Completion (Estimated)
July 1, 2027
Study Completion (Estimated)
July 1, 2027
Last Updated
September 17, 2025
Record last verified: 2025-09