Differences in resting metabolic rate between paraplegic and able-bodied subjects are explained by differences in body composition

Buchholz, Annick; McGillivray, Colleen; Pencharz, Paul B.

doi:10.1093/ajcn/77.2.371

Cited by 166 publications

(142 citation statements)

References 39 publications

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“…20,21 The reason for these shifts in body composition have been well documented. 19,21,22 Following SCI, LBM begins to atrophy below the level of injury and is replaced by BF. 23 This disproportionate amount of fat in individuals with SCI has serious implications for long-term morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

The effects of an anabolic agent on body composition and pulmonary function in tetraplegia: a pilot study

et al. 2009

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Study design: Prospective repeated-measures longitudinal study. Objectives: To determine if an 8-week course of an oral anabolic steroid can positively effect body composition or pulmonary function in healthy individuals with chronic tetraplegia. Setting: United States. Methods: Oxandrolone (20 mg per day) was administered for 8 weeks to 10 men with motor complete tetraplegia. Dual X-ray absorptiometry scans, pulmonary function tests (PFTs), serum lipids and liver function tests (LFTs) were obtained at baseline, 4,8,12 and 20 weeks. To analyze change over time, a repeated measures General Linear Model and nonparametric tests were utilized. Results: Following treatment, total lean body mass (LBM) increased 1.9% and LBM of the arms increased 5.4%. Total body fat decreased 1.5%, and increased 3.9% in the arms and, on average, combined measures of PFTs improved 2.2%. High-density lipoprotein cholesterol decreased 31.8%, low density lipoprotein cholesterol increased 41.2%, and LFTs increased 9.7-65.6% while on therapy but all trended to baseline at 20 weeks. Conclusion: Baseline body composition was characterized by a high proportion of fat and a body mass index that underestimated chronic disease risk. Treatment with oxandrolone was associated with modest improvements in PFTs and in arm and total body LBM. Unfavorable changes in serum lipids and LFTs indicate that reported benefits of using oxandrolone in this population must be carefully weighed against potential adverse effects.

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Section: Discussionmentioning

confidence: 99%

The effects of an anabolic agent on body composition and pulmonary function in tetraplegia: a pilot study

et al. 2009

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“…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.…”

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

confidence: 99%

“…12 Mean BMI values in studies of persons with long-standing SCI range from 20 to 27, 5,6,10,[13][14][15][16][17][18] consistent with the classifications of normal and overweight, but inconsistent with classification based on measured percent fat mass. [4][5][6][7][8][9][10][11] One reason for the underestimation of obesity using BMI may be the potential measurement error associated with determination of weight and/or height in persons with SCI. While weight can be measured using a wheelchair scale, an accurate height is difficult to obtain in those who are wheelchair dependent.…”

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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“…Height and weight were measured, and BMI was calculated using body weight/height squared (kg/m 2 ). Waist circumference (WC) was measured at the level of the lowest rib and classified based on standard classification (male: >102 cm, female: >88 cm) [15]. Blood pressure (BP) was measured on the right arm in the sitting position after a 5 min rest by auscultation using a stethoscope twice (6 h interval), and the mean of these was used.…”

Section: Anthropometric Measurementsmentioning

confidence: 99%

Cardiometabolic risk factors in Iranians with spinal cord injury: Analysis by injury-related variables

Sabour

Javidan²,

Ranjbarnovin³

et al. 2013

JRRD

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Abstract-Persons with spinal cord injury (SCI) have a high prevalence of abnormalities in carbohydrate and lipid metabolism. These abnormalities cause adverse coronary heart disease (CHD) in patients with SCI. In this study, we performed a detailed analysis of the level-specific cardiometabolic risk factors in individuals with SCI and analyzed the association of injury level on these risk factors. This was a cross-sectional study of 162 patients with SCI, assessing the prevalence of diabetes mellitus, dyslipidemia, hypertension, obesity, and smoking. Fasting blood sugar (>100) was diagnosed in 27 patients (16.7%). Of the total patients, 36 (22.2%) had a total cholesterol (TC) level of >200. A triglyceride level of >150 was present in 56 patients (34.6%). Hypertension was present in 2.5% of the entire patient group. Body mass index (BMI), TC, and low-density lipoprotein cholesterol (LDL-C) were significantly higher in the paraplegia group than the tetraplegia group (24.44 +/-4.23 vs 22.65 +/-4.27, p = 0. 01; 185.71 +/-40.69 vs 163.28 +/-37.92, p < 0.001; and 102.51 +/-28.20 vs 89.15 +/-22.35, p = 0.01, respectively). Patients with paraplegia may have increased hypertension, higher BMI, and increasing levels of serum LDL-C and TC than those with tetraplegia. Conventional risk factors for CHD should be identified and treated in individuals with SCI.

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Differences in resting metabolic rate between paraplegic and able-bodied subjects are explained by differences in body composition

Abstract: FFM, BCM, and RMR, but not obligatory TEF, are lower in paraplegics than in control subjects. RMR does not differ between control and paraplegic subjects after adjustment for FFM, indicating similar metabolic activity in the fat-free compartment of the body.

Cited by 166 publications

References 39 publications

The effects of an anabolic agent on body composition and pulmonary function in tetraplegia: a pilot study

The effects of an anabolic agent on body composition and pulmonary function in tetraplegia: a pilot study

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

Cardiometabolic risk factors in Iranians with spinal cord injury: Analysis by injury-related variables

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