The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury

Farkas, Gary J.; Burton, Adam M.; McMillan, David W.; Sneij, Alicia; Gater, David R.

doi:10.3390/jpm12071088

Cited by 17 publications

(16 citation statements)

References 202 publications

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“…The underconsumption of protein as a function of BW may result from persons with chronic SCI that are overweight/obese underreporting dietary intake (as described above) or consuming a diet predominantly composed of fat and carbohydrate (i.e., convenience and snack food). This dietary pattern is of concern because high-fat and sugary diets contribute to obesity and cardiovascular disease risk after SCI (66) . With time, underconsumption of dietary protein may contribute to the loss of FFM and an increase in fat mass as BMR decreases.…”

Section: Discussionmentioning

confidence: 99%

The comparison of total energy and protein intake relative to estimated requirements in chronic spinal cord injury

Farkas,

Berg,

Sneij

et al. 2023

Br J Nutr

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In chronic spinal cord injury (SCI), individuals experience dietary inadequacies complicated by an understudied research area. Our objectives were to assess (1) the agreement between methods of estimating energy requirement (EER) and estimated energy intake (EEI) and (2) whether dietary protein intake met SCI-specific protein guidelines. Persons with chronic SCI (n=43) completed 3-day food records to assess EEI and dietary protein intake. EER was determined with the Long and Institute of Medicine (IOM) methods and the SCI-specific Farkas method. Protein requirements were calculated as 0.8-1.0 g/kg of body weight (BW)/day. Reporting accuracy and bias were calculated and correlated to body composition. Compared to IOM and Long methods (P<0.05), the SCI-specific method did not overestimate the EEI (P=0.200). Reporting accuracy and bias were best for SCI-specific (98.9%, -1.12%) compared to Long (94.8%, -5.24%) and IOM (64.1%, -35.4%) methods. BW (r=-0.403), body mass index (r=-0.323), and total fat mass (r =-0.346) correlated with the IOM reporting bias (all, P<0.05). BW correlated with the SCI-specific and Long reporting bias (r=-0.313, P=0.041). Seven (16%) participants met BW-specific protein guidelines. The regression of protein intake on BW demonstrated no association between the variables (β=0.067, P=0.730). In contrast, for every 1 kg increase in BW, the delta between total and required protein intake decreased by 0.833 g (P=0.0001). The SCI-specific method for EER had the best agreement with the EEI. Protein intake decreased with increasing BW, contrary to protein requirements for chronic SCI.

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Section: Discussionmentioning

confidence: 99%

The comparison of total energy and protein intake relative to estimated requirements in chronic spinal cord injury

Farkas,

Berg,

Sneij

et al. 2023

Br J Nutr

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“…CMR denotes a constellation of modifiable and nonmodifiable risk factors that heighten the susceptibility to cardiovascular disease (Fig. 1) [28], with hypertension, heart failure, cardiac dysrhythmias, and atherosclerosis as significant contributions to cardiovascular morbidity in SCI [29 ▪▪ ]. Similarly, cardiometabolic syndrome (CMS) arises from the clustering of distinct endometabolic and vascular abnormalities, presenting itself as both a “silent killer” and an “early warning signal” for chronic and potentially disabling disorders (Fig.…”

Section: Cardiometabolic Risk and Syndromementioning

confidence: 99%

“…1). While the definitions for specific component risk factors of CMS may not entirely align [28], their collective presence amplifies the threat of common chronic cerebrovascular, cardiovascular, endocrine, and neurological disorders associated with disability [30]. Commonly recognized component risk factors for CMS are dyslipidemia, hypertension, dysglycemia/insulin resistance, and obesity [31].…”

Section: Cardiometabolic Risk and Syndromementioning

confidence: 99%

Assessing the efficacy of duration and intensity prescription for physical activity in mitigating cardiometabolic risk after spinal cord injury

Farkas,

Caldera,

Nash

2023

Current Opinion in Neurology

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Purpose of review Spinal cord injury (SCI) heightens susceptibility to cardiometabolic risk (CMR), predisposing individuals to cardiovascular disease. This monograph aims to assess the optimal duration and intensity of physical activity (PA) for managing CMR factors, particularly obesity, after SCI and provide modality-specific PA durations for optimal energy expenditure. Recent findings PA guidelines recommend at least 150 min/week of moderate-intensity activity. However, non-SCI literature supports the effectiveness of engaging in vigorous-intensity PA (≥6 METs) and dedicating 250–300 min/week (≈2000 kcal/week) to reduce CMR factors. Engaging in this volume of PA has shown a dose-response relationship, wherein increased activity results in decreased obesity and other CMR factors in persons without SCI. Summary To optimize cardiometabolic health, individuals with SCI require a longer duration and higher intensity of PA to achieve energy expenditures comparable to individuals without SCI. Therefore, individuals with SCI who can engage in or approach vigorous-intensity PA should prioritize doing so for at least 150 min/wk. At the same time, those unable to reach such intensities should engage in at least 250–300 min/week of PA at a challenging yet comfortable intensity, aiming to achieve an optimal intensity level based on their abilities. Given the potential to decrease CMR after SCI, increasing PA duration and intensity merits careful consideration in future SCI PA directives.

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“…In micro, overcoming these challenges can ensure the survival and vitality of endogenous and exogenous cells. In macro, insurance of vitality of cells can mitigate various syndromes of SCI, 34,137 like edema, hemorrhage, formation of cystic cavities, and ischemia. A deeper understanding of the mechanisms of how endogenous and exogenous cells facilitate functional recovery, as well as the acknowledgment of challenges of applying these therapies in clinical use and effectively constructing the spinal cord model, will be of huge importance to achieving successful SCI surgeries.…”

Section: Conclusion and Perspectivementioning

confidence: 99%

Current treatments after spinal cord injury: Cell engineering, tissue engineering, and combined therapies

Shen

Cao

et al. 2022

Smart Medicine

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Both traumatic and non‐traumatic spinal cord injuries (SCIs) can be categorized as damages done to our central nervous system (CNS). The patients' physical and mental health may suffer greatly because of traumatic SCI. With the widespread use of motor vehicles and increasingly aged population, the occurrence of SCI is more frequent than before, creating a considerable burden to global public health. The regeneration process of the spinal cord is hampered by a series of events that occur following SCI like edema, hemorrhage, formation of cystic cavities, and ischemia. An effective strategy for the treatment of SCI and functional recovery still has not been discovered; however, recent advances have been made in bioengineering fields that therapies based on cells, biomaterials, and biomolecules have proved effective in the repair of the spinal cord. In the light of worldwide importance of treatments for SCI, this article aims to provide a review of recent advances by first introducing the physiology, etiology, epidemiology, and mechanisms of SCI. We then put emphasis on the widely used clinical treatments and bioengineering strategies (cell‐based, biomaterial‐based, and biomolecule‐based) for the functional regeneration of the spinal cord as well as challenges faced by scientists currently. This article provides scientists and clinicians with a comprehensive outlook on the recent advances of preclinical and clinical treatments of SCI, hoping to help them find keys to the functional regeneration of SCI.

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The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury

Cited by 17 publications

References 202 publications

The comparison of total energy and protein intake relative to estimated requirements in chronic spinal cord injury

The comparison of total energy and protein intake relative to estimated requirements in chronic spinal cord injury

Assessing the efficacy of duration and intensity prescription for physical activity in mitigating cardiometabolic risk after spinal cord injury

Current treatments after spinal cord injury: Cell engineering, tissue engineering, and combined therapies

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