Associations between serum lipids and indicators of adiposity in men with spinal cord injury

Maki, Kevin C.; Briones, E; Langbein, W. Edwin; Inman-Felton, A.; Nemchausky, Bernard M.; Welch, Michael J.; Burton, Jeffrey R.

doi:10.1038/sc.1995.24

Cited by 91 publications

(77 citation statements)

References 30 publications

(14 reference statements)

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“…8,21 The present study, on the contrary, showed more favorable lipid and (apo)lipoprotein values, despite the signi®cant increase of body mass and BMI between t1 and t2. However, the lack of change in the sum of four skinfolds suggests that the change in body mass was the consequence of an increased muscle mass, instead of an increase in adipose tissue.…”

Section: Determinants Of Changes In Lipid and (Apo)lipoprotein Pro®lescontrasting

confidence: 73%

Changes in lipid, lipoprotein and apolipoprotein profiles in persons with spinal cord injuries during the first 2 years post-injury

et al. 1999

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Objective: To investigate changes in lipid, lipoprotein and apolipoprotein pro®les in persons with spinal cord injury (SCI) during the ®rst 2 years post-injury, and to determine whether changes in risk pro®les were associated with sport activity and/or changes in physical capacity parameters. Design: Risk pro®les and physical capacity were investigated in 19 subjects with recent SCI during rehabilitation (t1) and +1 year after discharge from rehabilitation (t2). Main outcome measures: Changes in total plasma cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein-A1 (ApoA1), apolipoprotein-B (ApoB) concentrations, the ratios TC/HDL-C, LDL-C/HDL-C, ApoA1/ApoB and HDL-C/ApoA1, and physical capacity (maximal isometric strength, sprint power output, maximal power output, aerobic power). Results: Risk pro®le parameters changed towards more favorable values at t2, except for HDL-C (P=0.06), TG and HDL-C/ApoA1. Sport activity and changes of the physical capacity were the most important determinants of changes in lipid and (apo)lipoprotein pro®les, showing more favorable values with larger increases of the physical capacity and in persons who were physically active. Conclusion: Results show that the lipid and (apo)lipoprotein pro®les improve in persons with SCI during the ®rst 2 years post-injury, and that improving the physical capacity or being physically active can improve the lipid and (apo)lipoprotein pro®les.

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Section: Determinants Of Changes In Lipid and (Apo)lipoprotein Pro®lescontrasting

confidence: 73%

Changes in lipid, lipoprotein and apolipoprotein profiles in persons with spinal cord injuries during the first 2 years post-injury

et al. 1999

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“…Three studies 11,15,63 have measured waist circumference in subjects with chronic SCI. Jeon et al 11 did not report values, nor was the method of obtaining waist circumference described.…”

Section: Body Mass Index (Bmi) As a Marker Of Obesity In Chronic Scimentioning

confidence: 99%

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

2005

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Study design: Literature review. Background: Increased fat mass and coronary heart disease (CHD) are secondary complications of chronic spinal cord injury (SCI). In able-bodied populations, body mass index (BMI, body weight (kg)/height (m 2 )) is a widely used surrogate marker of obesity and predictor of CHD risk. Waist circumference, an accurate and reproducible surrogate measure of abdominal visceral adipose tissue, is also associated with CHD risk (more so than BMI) in able-bodied populations. Objective: To review the literature on the accuracy of BMI and waist circumference as surrogate measures of obesity and CHD risk in persons with chronic SCI. Setting: Ontario, Canada. Methods: Literature review. Results: In the SCI population, BMI is an insensitive marker of obesity, explains less of the variance in measured percent fat mass than in the able-bodied, and is inconsistently related to CHD risk factors. This may be due to potential measurement error, and to the inability of BMI to distinguish between fat and fat-free mass and to measure body fat distribution. Waist circumference has not been validated as a surrogate measure of visceral adipose tissue, however preliminary evidence supports a relationship between waist circumference and CHD risk in the SCI population. Conclusions: We recommend that SCI-specific BMI classifications be determined. We also recommend that accuracy and reliability of waist circumference as a surrogate measure of visceral adipose tissue and CHD risk be determined in men and women with long-standing paraplegia and tetraplegia. Body mass index (BMI) as a marker of obesity in chronic SCIObesity is defined as an excess accumulation of fat mass. Able-bodied men and women p40 years are considered obese when fat mass exceeds 22-25 and 35% of body weight, respectively. 1,2 As individuals age, fat mass accrues at the expense of fat-free mass, so that at older ages percentage fat mass is higher, even in individuals who do not gain weight. 3 Thus, obesity in 41-60-yearold able-bodied men and women can be defined as a fat mass 425 and 438% of body weight, respectively. 2 Mean percent fat mass (measured by dual energy X-ray absorptiometry (DXA), isotope dilution or the threecompartment model) reported in cross-sectional studies of persons (mostly men) with chronic spinal cord injury (SCI) ranges from 23 to 35%. [4][5][6][7][8][9][10][11] The percentage of body weight as fat mass is 8-18% higher in SCI versus age-, height-and/or weight-matched able-bodied control subjects. These values are often consistent with the above definitions of obesity, and are summarized in Table 1. Accurate classification of an individual as normal weight, overweight or obese requires measurement of body composition. However, measuring fat mass can be difficult and expensive, and no accurate method is easily available for routine clinical use. Therefore, the body mass index (BMI) is widely used. Expressed as weight (kg) divided by height (m 2 ), BMI allows classification of able-bodied adults as underweight, normal we...

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“…176 ± 178 Ine ective orthostatic circulatory regulation is associated with notable problems for patients with SCI and may contribute to the increased prevalence of cardiovascular disease in this population. 64 The combination of the loss of peripheral sympathetic vasomotor tone, reduce lower extremity skeletal muscle pump, attenuated venous return, and depressed baroreceptor sensitivity results in signi®cant alterations of the cardiovascular system.…”

Section: Thoracic Autonomic Dysfunctionmentioning

confidence: 99%

Risk factors for atherogenesis and cardiovascular autonomic function in persons with spinal cord injury

et al. 1999

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Persons with spinal cord injury (SCI) have been recognized to have several metabolic changes that adversely impact their risk for cardiovascular disease. An increased prevalence of disorders of carbohydrate metabolism and dyslipidemia may be related predominantly to paralysis with immobilization and associated loss of lean body tissue and gain in relative adiposity. Studies have reported an increased risk of vascular disease in those with SCI. As such, an understanding of the constellation of carbohydrate and lipid changes that occur after SCI is relevant to the clinical practice of medicine in this population. Oral glucose tolerance testing and associated studiesImpaired glucose tolerance and diabetes mellitus are more prevalent in individuals with SCI than in those who are able-bodied. 1 ± 4 In most of the individuals with SCI and abnormal carbohydrate tolerance, resistance to insulin mediation of glucose uptake by peripheral tissues may be demonstrable. In the presence of insulin resistance, the normal homeostatic response to glucose challenge is increased pancreatic b-cell secretion of insulin. If the compensatory response of the pancreas is insu cient to control the serum glucose concentration, worsening of carbohydrate tolerance will ensue.Bauman et al 3 performed a 75 g oral glucose tolerance test in 100 male veterans with SCI and in 50 able-bodied veteran controls. According to criteria established by the World Health Organization, 5 22% of those with SCI were diabetic whereas only 6% of the control group were diabetic. Eighty-two per cent of the controls had normal oral glucose tolerance, compared with 38% of those with quadriplegia and 50% of those with paraplegia. Subjects with SCI had signi®cantly higher mean plasma glucose and insulin values at several points during the oral glucose tolerance test when compared with controls ( Figure 1). In subgroups, determinants of insulin sensitivity were measured: per cent lean body mass, per cent fat mass, and cardiopulmonary ®tness. Values for insulin sensitivity were linearly related with those of ®tness (VO 2 max) determined from a progressive incremental upper-body exercise stress test. Insulin sensitivity was suggestively correlated with lean body mass, and negatively correlated with body fat. Thus, in a relatively small subgroup of untrained subjects with paraplegia, the strongest determinant of insulin sensitivity was cardiopulmonary ®tness.In 201 non-veteran subjects with SCI, Bauman et al 2 studied the relationship of oral carbohydrate tolerance after a 75 g glucose load to several variables, including level and completeness of lesion, gender, ethnicity, age, duration of injury, and anthropometric measures. Of the total group, 27 (13%) had diabetes mellitus and 56 (29%) had impaired glucose tolerance. 2,6 The subjects with complete tetraplegia had sign®cantly worse carbohydrate tolerance (Figure 2) and were more frequently classi®ed with a disorder of carbohydrate tolerance than the other neurological de®cit subgroups. 2 There were no signi®cant gend...

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Associations between serum lipids and indicators of adiposity in men with spinal cord injury

Cited by 91 publications

References 30 publications

Changes in lipid, lipoprotein and apolipoprotein profiles in persons with spinal cord injuries during the first 2 years post-injury

Changes in lipid, lipoprotein and apolipoprotein profiles in persons with spinal cord injuries during the first 2 years post-injury

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

Risk factors for atherogenesis and cardiovascular autonomic function in persons with spinal cord injury

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