Body composition and resting energy expenditure in long term spinal cord injury

Sedlock, Darlene A.; Laventure, S J

doi:10.1038/sc.1990.60

Cited by 81 publications

(63 citation statements)

References 13 publications

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“…44,45 BWSTT did not prevent an increase in fat deposition in our participants with acute SCI. This may be related to reductions in overall activity level and/or metabolic rate that occurred with immobilization and muscle atrophy and/or impairment in catecholamine release associated with lesions above T6 and subsequent lack of inhibition of hormones involved in fat metabolism.…”

Section: Effects Of Bwstt On Muscle and Fatmentioning

confidence: 96%

Body weight supported treadmill training in acute spinal cord injury: impact on muscle and bone

et al. 2005

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Design: Longitudinal prospective case series. Objective: To evaluate the impact of early introduction postspinal cord injury (SCI) of twiceweekly body-weight supported treadmill training (BWSTT) on muscle and bone. Setting: Centre for Health Promotion and Rehabilitation, McMaster University, Canada. Methods: Five individuals who had sustained traumatic SCI within 2-6 months participated in the study. Bone mineral densities (BMD) of proximal femur, distal femur, proximal tibia and lumbar spine were measured before and after training, as well as muscle cross-sectional area (CSA), BMD and bone geometry at mid-femur and proximal tibia. Serum osteocalcin and urinary deoxypyridinoline were measured at baseline, and after 24 and 48 sessions of training. Results: All participants experienced increased muscle CSAs, ranging from 3.8 to 56.9%. Reductions in BMD were evident in all participants at almost all lower limb sites after training, ranging in magnitude from À1.2 to À26.7%. Lumbar spine BMD changes ranged from 0.2 to À7.4%. No consistent changes were observed in bone geometry. BWSTT did not alter the expected pattern of change in bone biochemical markers over time. The individual with the greatest improvement in ambulatory ability demonstrated the smallest reduction in lower limb BMD. Conversely, the individual who completed the fewest BWSTT sessions demonstrated the greatest reductions in BMD. Conclusions: Twice-weekly BWSTT appeared to partially reverse muscle atrophy after SCI, but did not prevent bone loss. Larger, controlled trials should evaluate whether relative preservation of bone loss occurs with regular BWSTT following acute SCI. Sponsorship: Ontario Neurotrauma Foundation.Spinal Cord (2005) 43, 649-657.

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Section: Effects Of Bwstt On Muscle and Fatmentioning

confidence: 96%

Body weight supported treadmill training in acute spinal cord injury: impact on muscle and bone

et al. 2005

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“…With previous work suggesting that REE does not differ between paraplegic and ablebodied subjects after adjustment for fat-free mass and body cell mass, 7 further research on the role of body composition as a predictor of energy needs may be worthwhile. Bauman et al 31 Harris Benedict 1747 ± 143 1324 ± 187 c +32 Sedlock and Laventure 33 Cunningham 1718 ± 150 1530 ± 330 +12…”

Section: Discussionmentioning

confidence: 99%

Investigation of measured and predicted resting energy needs in adults after spinal cord injury: a systematic review

et al. 2015

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Background: Accurate estimation of energy needs is vital for effective nutritional management of individuals with spinal cord injury (SCI). Inappropriate energy prescription after SCI can compound the rates of malnutrition or obesity, increase the risk of complications and negatively influence outcomes. Energy requirements following SCI are not well understood, and there is currently no universally accepted method of estimating energy needs in clinical practice. Study design: This is a systematic literature review. Objectives: The objectives of this study were to investigate and compare the measured resting energy needs of adults with SCI across different phases of rehabilitation, and to identify appropriate energy prediction equations for use in SCI. Setting: This study was conducted in Australia. Methods: MEDLINE, EMBASE and CENTRAL databases were searched for studies published between 1975 and April 2015, identifying 298 articles. Full articles in English language of adults with SCI who were fasted for a minimum of 8 hours before undergoing indirect calorimetry to measure resting energy expenditure (REE) for at least 20 min were selected. On the basis of the inclusion criteria, 18 articles remained for data extraction. One author extracted information from all articles, and inter-rater reliability was tested in five articles. Results: REE across three phases of injury was assessed: acute, sub-acute and chronic. Few studies (n = 2) have investigated REE in the acute and sub-acute injury stages of SCI recovery. The factors influencing chronic energy needs in SCI patient populations are many and varied, and a valid predictive equation for use in SCI remains elusive. SCI is initially associated with catabolic conditions of trauma such as spinal shock and patients may be at risk of weight loss, malnutrition and pressure injuries. 1 In the long term, SCI results in marked body composition changes, specifically muscle atrophy below the level of injury and higher relative fat mass compared with people without SCI, 1-3 which may contribute to decreases in resting energy expenditure (REE). In an environment of reduced mobility, energy needs are further reduced, and there is an increased risk of weight gain and obesity-related chronic diseases. 4,5 To prescribe an appropriate daily energy intake, an individual's total daily energy expenditure (TDEE) must be determined. An individual's TDEE comprises three components, two of which may be considerably affected by SCI. Basal metabolic rate (BMR) is the minimum energy required for the basal processes of life, and it contributes the majority (~70%) of TDEE in a healthy person. 6 In the clinical literature, the term BMR is often used interchangeably with REE, and for the purpose of this review REE is defined as the energy expended in an awake, alert individual in a rested position following

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“…These include isotope-labelled water, 12 total body potassium counting, 13,14 anthropometric measures, 15 hydrodensitometry, 13,16 dual photon absorptiometry (DPA), 14,17,18 and dual energy X-ray absorptiometry (DEXA). 1 ± 3 However, some of these methods are not particularly suitable for use in the SCI population.…”

Section: Introductionmentioning

confidence: 99%

“…Hydrodensitometry is a di cult technique for people with restricted mobility and where the level of the cord lesion compromises respiratory muscle function, lung volume measurements are inaccurate. 16 Anthropometric measures tend to underestimate fat per cent when compared with able bodied individuals. 15 Equations necessary for the estimation of body composition from these two techniques are derived solely from able-bodied individuals and as such may not be the most appropriate for determining body composition in SCI.…”

Section: Introductionmentioning

confidence: 99%

DEXA: a practical and accurate tool to demonstrate total and regional bone loss, lean tissue loss and fat mass gain in paraplegia

1998

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Persons with spinal cord injury lose lean tissue mass and bone but gain body fat. There is a need to quantify the magnitude of these changes in body composition because there are associated skeletal and cardiovascular health risks. We have compared total body and regional (lower limb) di erences in body composition in a group of males with paraplegia and in healthy able-bodied males matched for age, and height using dual energy X-ray absorptiometry. Although patients and controls had similar body mass indices, signi®cant reductions in lean tissue mass (16% less) and bone (12% less) were observed in those with spinal cord injury. Group di erences were even more pronounced in the lower limb. DEXA also revealed large increases in fat mass in subjects who did not look obese, total fat mass being 47% higher in the paraplegic group. We suggest that DEXA provides a simple and practical means to quantify both whole body and regional changes in body composition associated with spinal cord injury.

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Body composition and resting energy expenditure in long term spinal cord injury

Cited by 81 publications

References 13 publications

Body weight supported treadmill training in acute spinal cord injury: impact on muscle and bone

Body weight supported treadmill training in acute spinal cord injury: impact on muscle and bone

Investigation of measured and predicted resting energy needs in adults after spinal cord injury: a systematic review

DEXA: a practical and accurate tool to demonstrate total and regional bone loss, lean tissue loss and fat mass gain in paraplegia

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