Urine samples are collected before DLW administration (baseline) and multiple times during the week. The DLW is produced by combining 10% 18O and 99.9% 2H, and the DLW composed of 1.2-1.8 g of 18O and 0.06 - 0.07 g of 2H is administered according to the recipient’s body weight. The following briefly describes the DLW method used by our research team 6, 10- 14. When there is no weight change in the athlete during a week or two of the test period for obtaining DLW data, it is assumed that the TEE is identical to the daily EER 6. As the gold standard for TEE measurement, the DLW method is known as the most objective and accurate one 7- 9. The DLW method using stable isotopes of hydrogen and oxygen (2H and 18O) has been used worldwide in humans for about 60 years 7. Therefore, our study aims to review PAL data from DLW studies focusing on female athletes and to understand the methods of assessing athletes’ EERs in the field. However, there are no reviews on PAL data obtained by the DLW method in female athletes or methods of calculating EER in athletes. As individual RMR has a very narrow range of variance, the differences in the PAL determine the differences in the EER 6. A crucial index, EER is measured by the physical activity level (PAL) and the TEE divided by the resting metabolic rate (RMR). To reduce the problems of the FAT, estimating daily calorie intake is essential for establishing detailed nutritional intake strategies 1, 2.Ĭurrently, the doubly labeled water method (DLW) is the gold standard for measuring total energy expenditure (TEE) and calculating the estimated energy requirement (EER) in athletes 6. ![]() These interrelated problems lead to not only decline in performance due to stress and chronic fatigue, but also sports injuries such as fatigue fractures 3- 5. In female endurance runners or gymnasts, chronic energy deficiency, when energy intake cannot meet the energy expenditure from high-intensity training, leads to amenorrhea and osteoporosis, creating the female athlete triad (FAT) 1, 2.
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