Post-traumatic changes in energy expenditure and body composition in patients with acute spinal cord injury

Abstract

After an initial decrease in resting energy expenditure, body weight and percentage of body fat, these values levelled off during the rehabilitation period. After the end of the rehabilitation period, body weight and body fat mass increased again to the baseline levels, whereas resting energy expenditure decreased further. These results suggest that rehabilitation programmes should focus on adapting to these foreseeable changes.

Comparison of estimated energy requirements using predictive equations with total energy expenditure measured by the doubly labelled water method in acute spinal cord injury

“…Patients with SCI who had sustained an acute traumatic complete (AIS A) or incomplete SCI (AIS B, C, D) above T12, according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) criteria, were screened for eligibility. 'Acute' was defined as within 8 weeks post-SCI, since nutritional depletion based on anthropometry [1,4], biochemistry [1] and negative nitrogen balance [1] has been reported within this timeframe. Participants were medically stable, able to provide informed (written or witnessed, verbal) consent and medically and surgically cleared to participate.…”

“…The metabolic response to acute SCI within the first 7 weeks is not well understood, although nitrogen loss and decreased protein synthesis, whole-body energy stores and lean muscle mass have been reported. Despite the importance of appropriate nutrition, few studies have examined energy requirements in acute SCI [3][4][5][6][7][8].…”

“…While metabolic demand may be heightened during the initial catabolic phase, energy requirements during rehabilitation and chronic phases gradually decline to below prior to injury or those of controls [9,10]. The transition from the catabolic phase to decreased energy needs is not well defined although resting energy expenditure (REE) has been reported to decrease after 10 weeks [4]. Energy needs may be affected by multiple factors including level [8] and completeness of injury [11], body composition [9,12], presence of infection or pressure injuries [13] and activity [11].…”

Quantifying sublethal Florida manatee-watercraft interactions by examining scars on manatee carcasses

“…One in 4 manatees that reach adulthood is hit by watercraft at least 10 times. The long-term consequences of sublethal in jury resulting in scarring are not fully understood, but short-term consequences include pain, elevated stress responses, and behavioral changes, as well as increased energy expenditure (Felleiter et al 2017, 59.7 (±16.1) 7.9 (± 2.7) 1.5 (± 0.5) Subadult 67.1 (± 7.3) 22.6 (± 8.0) 2.1 (± 0.3) 0.4 (± 0.1) Calves 30.0 (±12.9) 5.8 (± 4.3) 0.6 (± 0.2) 0.1 (± 0.1) Lysiak et al 2018). Longer-term impacts include decreased mobility due to skeletal remodeling of fractured bone (Wright et al 1995), decreased swimming efficiency if large portions of the fluke are lost (Kojeszewski & Fish 2007), compromised immune function (Valvis et al 2015), and, if reproductive systems are damaged, decreased reproductive output.…”

Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge— protocol for a prospective national cohort study and a preintervention- postintervention study

“…Energy expenditure decreases significantly after sustaining a SCI and remains low. Although body fat and body weight decrease in the acute injury phase, they increase in the subacute phase, and a loss of lean body mass in the lower extremities and trunk has been observed during the first year after injury 9. BMI increases gradually during the first years after discharge from primary rehabilitation 10.…”