The Serum Lipoprotein Profile in Veterans With Paraplegia: The Relationship to Nutritional Factors and Body Mass Index

Zlotolow, Susan; Levy, Ezra; Bauman, William A.

doi:10.1080/01952307.1992.11735869

Cited by 60 publications

(37 citation statements)

References 22 publications

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“…This discrepancy has been documented previously, 9,[39][40][41] and likely reflects the fact that visceral fat (rather than total body fat or even abdominal fat) is thought to be the main contributor to CVD risk 14 and cannot be discerned from BMI measurements. 42 Even the ''gold standard'' of DEXA, which provides specific data on abdominal adiposity, does not have the ability to differentiate between subcutaneous and visceral fat.…”

Section: Discussionmentioning

confidence: 61%

Waist Circumference Is the Best Index for Obesity-Related Cardiovascular Disease Risk in Individuals with Spinal Cord Injury

Ravensbergen

Lear

Claydon

2014

Journal of Neurotrauma

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Obesity is an important identifier of cardiovascular disease (CVD) risk, but is challenging to determine accurately in individuals with spinal cord injury (SCI). Body mass index (BMI) is used worldwide as a simple indicator of obesity, but is difficult to measure in individuals with SCI. Furthermore, standard BMI cutoffs underestimate obesity in this population. Therefore, we aimed to identify the best marker of obesity in individuals with SCI, considering both practicality, and ability to detect adiposity and CVD risk. Five anthropometric measures were evaluated: BMI; waist circumference (WC); waist-to-height ratio (WHtR); waist-to-hip ratio; and neck circumference. We evaluated relationships between these measures and abdominal and total body-fat percentage, seven cardiovascular metabolic risk factors (fasting insulin, glucose, glucose tolerance, triglycerides, high-density lipoprotein, low-density lipoprotein, and total cholesterol), and the Framingham risk score. BMI, WC, and WHtR were correlated with abdominal fat percentage. WC and WHtR were correlated with five metabolic risk factors as well as the Framingham risk score. WC is a more practical measure for an SCI population. The optimal cutoff for identifying adverse CVD risk in individuals with SCI was identified as WC ‡ 94 cm, with 100% sensitivity and 79% specificity. We propose that WC is a simple, more sensitive alternative to BMI in this population that is easy to use in multiple settings. The cutoff provides a simple tool to predict adverse CVD risk profiles that can be used to guide risk management, as well as as a practical aid for individuals with SCI to maintain a healthy body composition.

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Section: Discussionmentioning

confidence: 61%

Waist Circumference Is the Best Index for Obesity-Related Cardiovascular Disease Risk in Individuals with Spinal Cord Injury

Ravensbergen

Lear

Claydon

2014

Journal of Neurotrauma

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“…Expressed as weight (kg) divided by height (m 2 ), BMI allows classification of able-bodied adults as underweight, normal weight, overweight or obese, using the World Health Organization criteria in Table 2. 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.…”

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

confidence: 92%

“…High-density lipoprotein (HDL) cholesterol levels are 20-42% lower (Po0.05) in persons with SCI than in able-bodied persons. 14,15,[35][36][37] Triglyceride levels are 6-60% higher in SCI, although not always significantly so. 15,[35][36][37][38] Total and low-density lipoprotein (LDL) cholesterols are either higher, similar, or lower, than in able-bodied subjects; 15,16,37,39,40 the relatively small number of subjects and differences in subject characteristics studied may account for these discrepancies.…”

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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“…A prior study of veterans with paraplegia compared with age-matched ambulatory veteran controls found a signi®cantly lower mean serum HDL cholesterol level in the group with SCI compared with able-bodied persons despite no signi®cant dierences noted for total caloric, saturated fat, or cholesterol intake between the groups. 35 A provocative ®nding in this study was the absence of a signi®cant dierence in mean serum HDL-c in female controls compared with those in the SCI group. Of note, a higher percentage of women in the control group were current smokers than in the SCI group, which may have depressed mean serum HDL-c values in the controls and contributed to the lack of dierence observed between the groups.…”

Section: Discussionmentioning

confidence: 99%

Is immobilization associated with an abnormal lipoprotein profile? Observations from a diverse cohort

et al. 1999

Spinal Cord

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Objective: The potential eects of ethnicity, gender, and adiposity on the serum lipid pro®le in persons with spinal cord injury (SCI) were determined. Subjects: Subjects with SCI were recruited during their annual physical examination from Rancho Los Amigos Medical Center, Downey, California. Sedentary able-bodied controls were Bridge and Tunnel Ocers of the Triboro Bridge and Tunnel Authority of the New York City metropolitan area. Methods: Serum lipid pro®les were investigated in 320 subjects with SCI and compared to those obtained from 303 relatively sedentary able-bodied controls. Serum lipid studies were obtained in the fasting state. Data were collected between 1993 and 1996. All lipid determinations were performed by the same commercial laboratory. Main outcome measures: The dependent variables were the values from the lipid pro®le analysis. The independent variables consisted of study group, gender, ethnic group, age, duration of injury, and anthropometric measurements. Results: The serum high-density lipoprotein cholesterol (HDL-c) level was reduced in the SCI compared with the control group (mean+SEM) (42+0.79 vs 47+0.67 mg/dl, P50.0005). The serum HDL-c level was signi®cantly lower in males with SCI than males in the control group (39+0.83 vs 45+0.70 mg/dl, P50.0001), but not for females (51+1.54 vs 54+1.52 mg/ dl, n.s.). Within the subgroups for whites and Latinos, HDL-c values were also lower in subjects with SCI than in controls (whites: 41+1.02 vs 46+0.86 mg/dl, P50.0001; Latinos: 37+1.53 vs 42+1.59 mg/dl, P50.05), but not for African Americans (49+1.56 vs 51+1.27 mg/dl, n.s.). African Americans had higher HDL-c values than whites or Latinos (SCI: 49+1.56 vs 41+1.02 or 37+1.53 mg/dl, P50.0001; controls: 51+1.27 vs 46+0.86 mg/ dl, P50.01 or 42+1.59 mg/dl, P50.0005). In persons with SCI, the serum HDL-c values were inversely related to body mass index and estimated per cent body fat (r=0.27, P50.0001). Conclusion: In white and Latino males, but not in females or African Americans, immobilization from SCI appears to be associated with lower HDL-c values than in controls.

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The Serum Lipoprotein Profile in Veterans With Paraplegia: The Relationship to Nutritional Factors and Body Mass Index

Cited by 60 publications

References 22 publications

Waist Circumference Is the Best Index for Obesity-Related Cardiovascular Disease Risk in Individuals with Spinal Cord Injury

Waist Circumference Is the Best Index for Obesity-Related Cardiovascular Disease Risk in Individuals with Spinal Cord 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

Is immobilization associated with an abnormal lipoprotein profile? Observations from a diverse cohort

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