1
|
Gilhooley SK, Bauman WA, La Fountaine MF, Cross GT, Kirshblum SC, Spungen AM, Cirnigliaro CM. Cardiometabolic risk factor clustering in persons with spinal cord injury: A principal component analysis approach. J Spinal Cord Med 2024; 47:627-639. [PMID: 37695205 PMCID: PMC11378671 DOI: 10.1080/10790268.2023.2215998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
CONTEXT/OBJECTIVE To identify cardiometabolic (CM) measurements that cluster to confer increased cardiovascular disease (CVD) risk using principal component analysis (PCA) in a cohort of chronic spinal cord injury (SCI) and healthy non-SCI individuals. APPROACH A cross-sectional study was performed in ninety-eight non-ambulatory men with chronic SCI and fifty-one healthy non-SCI individuals (ambulatory comparison group). Fasting blood samples were obtained for the following CM biomarkers: lipid, lipoprotein particle, fasting glucose and insulin concentrations, leptin, adiponectin, and markers of inflammation. Total and central adiposity [total body fat (TBF) percent and visceral adipose tissue (VAT) percent, respectively] were obtained by dual x-ray absorptiometry (DXA). A PCA was used to identify the CM outcome measurements that cluster to confer CVD risk in SCI and non-SCI cohorts. RESULTS Using PCA, six factor-components (FC) were extracted, explaining 77% and 82% of the total variance in the SCI and non-SCI cohorts, respectively. In both groups, FC-1 was primarily composed of lipoprotein particle concentration variables. TBF and VAT were included in FC-2 in the SCI group, but not the non-SCI group. In the SCI cohort, logistic regression analysis results revealed that for every unit increase in the FC-1 standardized score generated from the statistical software during the PCA, there is a 216% increased risk of MetS (P = 0.001), a 209% increased risk of a 10-yr. FRS ≥ 10% (P = 0.001), and a 92% increase in the risk of HOMA2-IR ≥ 2.05 (P = 0.01). CONCLUSION Application of PCA identified 6-FC models for the SCI and non-SCI groups. The clustering of variables into the respective models varied considerably between the cohorts, indicating that CM outcomes may play a differential role on their conferring CVD-risk in individuals with chronic SCI.
Collapse
Affiliation(s)
- Shawn K Gilhooley
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - William A Bauman
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
- Medical Service, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
- Departments of Medicine and Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael F La Fountaine
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
- Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA
- Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey, USA
| | - Gregory T Cross
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Steven C Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ann M Spungen
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
- Medical Service, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
- Departments of Medicine and Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| |
Collapse
|
2
|
Hansen RK, Samani A, Laessoe U, Handberg A, Mellergaard M, Figlewski K, Thijssen DHJ, Gliemann L, Larsen RG. Rowing exercise increases cardiorespiratory fitness and brachial artery diameter but not traditional cardiometabolic risk factors in spinal cord-injured humans. Eur J Appl Physiol 2023; 123:1241-1255. [PMID: 36781425 PMCID: PMC9924870 DOI: 10.1007/s00421-023-05146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE This study assessed the effects of upper-body rowing exercise on cardiorespiratory fitness, traditional cardiometabolic risk factors, and vascular health in individuals with spinal cord injury (SCI). METHODS Seventeen male and female adults with chronic (> 1 yr) motor-complete and incomplete SCI (level of injury: C4-L3) were randomized to control (CON, n = 9) or exercise (UBROW, n = 8). Participants in UBROW performed 12-week, 3 weekly sessions of 30-min upper-body ergometer rowing exercise, complying with current exercise guidelines for SCI. Cardiorespiratory fitness ([Formula: see text]O2peak), traditional risk factors (lipid profile, glycemic control) as well as inflammatory and vascular endothelium-derived biomarkers (derived from fasting blood samples) were measured before and after 6 (6W) and 12 weeks (12W). Brachial artery resting diameter and flow-mediated dilation (FMD) were determined by ultrasound as exploratory outcomes. RESULTS UBROW increased [Formula: see text]O2peak from baseline (15.1 ± 5.1 mL/kg/min; mean ± SD) to 6W (16.5 ± 5.3; P < 0.01) and 12W (17.5 ± 6.1; P < 0.01). UBROW increased resting brachial artery diameter from baseline (4.80 ± 0.72 mm) to 12W (5.08 ± 0.91; P < 0.01), with no changes at 6W (4.96 ± 0.91), and no changes in CON. There were no significant time-by-group interactions in traditional cardiometabolic blood biomarkers, or in unadjusted or baseline diameter corrected FMD. Explorative analyses revealed inverse correlations between changes (∆12W-baseline) in endothelin-1 and changes in resting diameter (r = - 0.56) and FMD% (r = - 0.60), both P < 0.05. CONCLUSION These results demonstrate that 12 weeks of upper-body rowing complying with current exercise guidelines for SCI improves cardiorespiratory fitness and increases resting brachial artery diameter. In contrast, the exercise intervention had no or only modest effects on traditional cardiometabolic risk factors. The study was registered at Clinicaltrials.gov (N-20190053, May 15, 2020).
Collapse
Affiliation(s)
- Rasmus Kopp Hansen
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark.
- Department of Research and Development, University College of Northern Jutland, Aalborg, Denmark.
| | - Afshin Samani
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark
| | - Uffe Laessoe
- Department of Research and Development, University College of Northern Jutland, Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Maiken Mellergaard
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Lasse Gliemann
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University Of Copenhagen, Copenhagen, Denmark
| | - Ryan Godsk Larsen
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark
| |
Collapse
|
3
|
Barton T, Low DA, Thijssen DHJ, Romviel S, Sloots M, Smit CAJ, Janssen TWJ. Twelve-Week Daily Gluteal and Hamstring Electrical Stimulation Improves Vascular Structure and Function, Limb Volume, and Sitting Pressure in Spinal Cord Injury: A Pilot Feasibility Study. Am J Phys Med Rehabil 2022; 101:913-919. [PMID: 36104843 DOI: 10.1097/phm.0000000000001929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined the long-term effects of low-intensity electrical stimulation on (micro)vasculature and sitting pressure of a home-based, wearable electrical stimulation device in a pilot feasibility study. DESIGN In a cohort observation before-after trial, nine middle-aged male (n = 8) and female (n = 1) individuals (48 ± 15 yrs) with American Spinal Injury Association A-C classified chronic (1-24 yrs) spinal cord injury underwent 12 wks of self-administered daily, low-intensity gluteal and hamstring electrical stimulation (50 Hz, 6 hrs [30-min electrical stimulation, 15-min rest]). Common femoral artery diameter and blood blow were determined with ultrasound, skin vascular function during local heating was assessed using Laser-Doppler flowmetry, thigh volume was estimated using leg circumferences and skinfolds, and interface sitting pressure was measured using pressure mapping. RESULTS Resting common femoral artery diameter increased (0.73 ± 0.20 to 0.79 ± 0.22 cm, P < 0.001) and baseline common femoral artery blood flow increased (0.28 ± 0.12 to 0.40 ± 0.15 l/min, P < 0.002). Gluteal cutaneous vascular conductance showed a time*temperature interaction (P = 0.01) with higher conductance at 42°C after 12 wks. Ischial peak pressure decreased (P = 0.003) by 32 ± 23 mm Hg and pressure gradient decreased (23 ± 7 to 16 ± 6 mm Hg, P = 0.007). Thigh volume increased (+19%, P = 0.01). CONCLUSIONS Twelve-week daily home-based gluteal and hamstring electrical stimulation is feasible and effective to improve (micro)vasculature and sitting pressure, and electrical stimulation may have clinical implications for ameliorating pressure ulcers and (micro)vascular complications in spinal cord injury.
Collapse
Affiliation(s)
- Thomas Barton
- From the Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom (TB, DAL, DHJT); Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (DHJT); Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands (SR, MS, CAJS, TWJJ); Department of Rehabilitation and Sports Medicine for Top Athletes, University Medical Center Utrecht, Utrecht, the Netherlands (MS); and Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (TWJJ)
| | | | | | | | | | | | | |
Collapse
|
4
|
Boehl G, Raguindin PF, Valido E, Bertolo A, Itodo OA, Minder B, Lampart P, Scheel-Sailer A, Leichtle A, Glisic M, Stoyanov J. Endocrinological and inflammatory markers in individuals with spinal cord injury: A systematic review and meta-analysis. Rev Endocr Metab Disord 2022; 23:1035-1050. [PMID: 35978214 PMCID: PMC9515048 DOI: 10.1007/s11154-022-09742-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 10/25/2022]
Abstract
Spinal cord injury (SCI) can lead to dramatic physiological changes which can be a factor in developing secondary health conditions and might be reflected in biomarker changes in this elevated risk group. We focused specifically on the endocrine and inflammation profile differences between SCI and able-bodied individuals (ABI). Our aim was to determine the differences in inflammatory markers and endocrine profiles between SCI and ABI. We systematically searched 4 electronic databases for relevant studies. Human observational (cross-sectional, cohort, case-control) studies that compared biomarkers of interest between SCI and ABI population were included. Weighted mean difference between SCI and ABI was calculated using random-effects models. Heterogeneity was computed using I2 statistic and chi-squared test. Study quality was evaluated through the Newcastle-Ottawa Scale. The search strategy yielded a total of 2,603 studies from which 256 articles were selected for full-text assessment. Sixty-two studies were included in the meta-analysis. SCI individuals had higher levels of pro-inflammatory C-reactive protein and IL-6 than ABI. Creatinine and 25-hydroxyvitamin D3 levels were lower in SCI than ABI. Total testosterone levels and IGF-1 were also found to be lower, while cortisol and leptin levels were higher in SCI when compared to ABI. Accordingly, meta-regression, subgroup analysis, and leave-one-out analysis were performed, however, they were only able to partially explain the high levels of heterogeneity. Individuals with SCI show higher levels of inflammatory markers and present significant endocrinological changes when compared to ABI. Moreover, higher incidence of obesity, diabetes, osteoporosis, and hypogonadism in SCI individuals, together with decreased creatinine levels reflect some of the readily measurable aspects of the phenotype changes in the SCI group. These findings need to be considered in anticipating medically related complications and personalizing SCI medical care.
Collapse
Affiliation(s)
| | - Peter Francis Raguindin
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Ezra Valido
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Alessandro Bertolo
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Orthopedic Surgery, University of Bern, Bern Inselspital, Bern, Switzerland
| | - Oche Adam Itodo
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Public Health & Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | | | | | - Alexander Leichtle
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Nottwil, Switzerland.
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| |
Collapse
|
5
|
Farkas GJ, Sneij A, McMillan DW, Tiozzo E, Nash MS, Gater DR. Energy expenditure and nutrient intake after spinal cord injury: a comprehensive review and practical recommendations. Br J Nutr 2022; 128:863-887. [PMID: 34551839 PMCID: PMC9389429 DOI: 10.1017/s0007114521003822] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Many persons with spinal cord injury (SCI) have one or more preventable chronic diseases related to excessive energetic intake and poor eating patterns. Appropriate nutrient consumption relative to need becomes a concern despite authoritative dietary recommendations from around the world. These recommendations were developed for the non-disabled population and do not account for the injury-induced changes in body composition, hypometabolic rate, hormonal dysregulation and nutrition status after SCI. Because evidence-based dietary reference intake values for SCI do not exist, ensuring appropriate consumption of macronutrient and micronutrients for their energy requirements becomes a challenge. In this compressive review, we briefly evaluate aspects of energy balance and appetite control relative to SCI. We report on the evidence regarding energy expenditure, nutrient intake and their relationship after SCI. We compare these data with several established nutritional guidelines from American Heart Association, Australian Dietary Guidelines, Dietary Guidelines for Americans, Institute of Medicine Dietary Reference Intake, Public Health England Government Dietary Recommendations, WHO Healthy Diet and the Paralyzed Veterans of America (PVA) Clinical Practice Guidelines. We also provide practical assessment and nutritional recommendations to facilitate a healthy dietary pattern after SCI. Because of a lack of strong SCI research, there are currently limited dietary recommendations outside of the PVA guidelines that capture the unique nutrient needs after SCI. Future multicentre clinical trials are needed to develop comprehensive, evidence-based dietary reference values specific for persons with SCI across the care continuum that rely on accurate, individual assessment of energy need.
Collapse
Affiliation(s)
- Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W. McMillan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduard Tiozzo
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark S. Nash
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
- South Florida Spinal Cord Injury Model System, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
- South Florida Spinal Cord Injury Model System, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
6
|
Bigford GE, Donovan A, Webster MT, Dietrich WD, Nash MS. Selective Myostatin Inhibition Spares Sublesional Muscle Mass and Myopenia-Related Dysfunction after Severe Spinal Cord Contusion in Mice. J Neurotrauma 2021; 38:3440-3455. [PMID: 34714134 DOI: 10.1089/neu.2021.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Clinically relevant myopenia accompanies spinal cord injury (SCI), and compromises function, metabolism, body composition, and health. Myostatin, a transforming growth factor (TGF)β family member, is a key negative regulator of skeletal muscle mass. We investigated inhibition of myostatin signaling using systemic delivery of a highly selective monoclonal antibody - muSRK-015P (40 mg/kg) - that blocks release of active growth factor from the latent form of myostatin. Adult female mice (C57BL/6) were subjected to a severe SCI (65 kdyn) at T9 and were then immediately and 1 week later administered test articles: muSRK-015P (40 mg/kg) or control (vehicle or IgG). A sham control group (laminectomy only) was included. At euthanasia, (2 weeks post-SCI) muSRK-015P preserved whole body lean mass and sublesional gastrocnemius and soleus mass. muSRK-015P-treated mice with SCI also had significantly attenuated myofiber atrophy, lipid infiltration, and loss of slow-oxidative phenotype in soleus muscle. These outcomes were accompanied by significantly improved sublesional motor function and muscle force production at 1 and 2 weeks post-SCI. At 2 weeks post-SCI, lean mass was significantly decreased in SCI-IgG mice, but was not different in SCI-muSRK-015P mice than in sham controls. Total energy expenditure (kCal/day) at 2 weeks post-SCI was lower in SCI-immunoglobulin (Ig)G mice, but not different in SCI-muSRK-015P mice than in sham controls. We conclude that in a randomized, blinded, and controlled study in mice, myostatin inhibition using muSRK-015P had broad effects on physical, metabolic, and functional outcomes when compared with IgG control treated SCI animals. These findings may identify a useful, targeted therapeutic strategy for treating post-SCI myopenia and related sequelae in humans.
Collapse
Affiliation(s)
- Gregory E Bigford
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | - W Dalton Dietrich
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mark S Nash
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Physical Therapy, University of Miami, Miami, Florida, USA
| |
Collapse
|
7
|
Farkas GJ, Sneij A, Gater DR. Dietetics After Spinal Cord Injury: Current Evidence and Future Perspectives. Top Spinal Cord Inj Rehabil 2021; 27:100-108. [PMID: 33814888 DOI: 10.46292/sci20-00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Following spinal cord injury (SCI), individuals are at high risk for obesity and several chronic cardiometabolic disorders due to a deterioration in body composition, hypometabolic rate, and endometabolic dysregulation. Countermeasures to the consequences of an SCI include adopting a healthy diet that provides adequate nutrition to maintain good body habitus and cardiometabolic health. A proper diet for individuals with SCI should distribute carbohydrates, protein, and fat to optimize a lower energy intake requirement and should stress foods with low caloric yet high nutrient density. The purpose of this article is to present available evidence on how nutritional status after SCI should advance future research to further develop SCI-specific guidelines for total energy intake, as it relates to percent carbohydrates, protein, fat, and all vitamins and minerals, that take into consideration the adaptations after SCI.
Collapse
Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.,The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
8
|
Bigford GE, Szeto A, Kimball J, Herderick EE, Mendez AJ, Nash MS. Cardiometabolic risks and atherosclerotic disease in ApoE knockout mice: Effect of spinal cord injury and Salsalate anti-inflammatory pharmacotherapy. PLoS One 2021; 16:e0246601. [PMID: 33626069 PMCID: PMC7904230 DOI: 10.1371/journal.pone.0246601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/21/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To test in mice with a double mutation of the ApoE gene (ApoE-/-) whether spinal cord injury (SCI) hastens the native trajectory of, and established component risks for, atherosclerotic disease (AD), and whether Salsalate anti-inflammatory pharmacotherapy attenuates the impact of SCI. METHODS ApoE-/- mice were anesthetized and underwent a T9 laminectomy. Exposed spinal cords were given a contusion injury (70 k-dynes). Sham animals underwent all surgical procedures, excluding injury. Injured animals were randomized to 2 groups: SCI or SCI+Salsalate [120 mg/Kg/day i.p.]. Mice were serially sacrificed at 20-, 24-, and 28-weeks post-SCI, and body mass was recorded. At sacrifice, heart and aorta were harvested intact, fixed in 10% buffered formalin, cleaned and cut longitudinally for en face preparation. The aortic tree was stained with oil-red-O (ORO). AD lesion histomorphometry was calculated from the proportional area of ORO. Plasma total cholesterol, triglycerides and proatherogenic inflammatory cytokines (PAIC's) were analyzed. RESULTS AD lesion in the aortic arch progressively increased in ApoE-/-, significant at 24- and 28-weeks. AD in SCI is significantly greater at 24- and 28-weeks compared to time-controlled ApoE-/-. Salsalate treatment attenuates the SCI-induced increase at these time points. Body mass in all SCI groups are significantly reduced compared to time-controlled ApoE-/-. Cholesterol and triglycerides are significantly higher with SCI by 24- and 28-weeks, compared to ApoE-/-, and Salsalate reduces the SCI-induced effect on cholesterol. PAIC's interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor α (TNFα), monocyte chemoattractant protein-1 (MCP-1), and chemokine (C-C motif) ligand 5 (CCL-5) are significantly greater with SCI compared to ApoE-/- at varying timepoints. Salsalate confers a marginal reducing effect on PAIC's by 28-weeks compared to SCI. Regression models determine that each PAIC is a significant and positive predictor of lesion. (p's <0.05). CONCLUSIONS SCI accelerates aortic AD and associated risk factors, and anti-inflammatory treatment may attenuate the impact of SCI on AD outcomes. PAIC's IL-1β, IL-6, TNFα, MCP-1, and CCL-5 may be effective predictors of AD.
Collapse
Affiliation(s)
- Gregory E. Bigford
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Angela Szeto
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - John Kimball
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | | | - Armando J. Mendez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Mark S. Nash
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Physical Therapy, University of Miami, Coral Gables, Florida, United States of America
| |
Collapse
|
9
|
McMillan DW, Nash MS, Gater DR, Valderrábano RJ. Neurogenic Obesity and Skeletal Pathology in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:57-67. [PMID: 33814883 PMCID: PMC7983641 DOI: 10.46292/sci20-00035] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Spinal cord injury (SCI) results in dramatic changes in body composition, with lean mass decreasing and fat mass increasing in specific regions that have important cardiometabolic implications. Accordingly, the recent Consortium for Spinal Cord Medicine (CSCM) released clinical practice guidelines for cardiometabolic disease (CMD) in SCI recommending the use of compartmental modeling of body composition to determine obesity in adults with SCI. This recommendation is guided by the fact that fat depots impact metabolic health differently, and in SCI adiposity increases around the viscera, skeletal muscle, and bone marrow. The contribution of skeletal muscle atrophy to decreased lean mass is self-evident, but the profound loss of bone is often less appreciated due to methodological considerations. General-population protocols for dual-energy x-ray absorptiometry (DXA) disregard assessment of the sites of greatest bone loss in SCI, but the International Society for Clinical Densitometry (ISCD) recently released an official position on the use of DXA to diagnose skeletal pathology in SCI. In this review, we discuss the recent guidelines regarding the evaluation and monitoring of obesity and bone loss in SCI. Then we consider the possible interactions of obesity and bone, including emerging evidence suggesting the possible influence of metabolic, autonomic, and endocrine function on bone health in SCI.
Collapse
Affiliation(s)
- David W. McMillan
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, Florida
- Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Mark S. Nash
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, Florida
- Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
- Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - David R. Gater
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, Florida
- Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Rodrigo J. Valderrábano
- Division of Endocrinology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| |
Collapse
|
10
|
McMillan DW, Maher JL, Jacobs KA, Nash MS, Gater DR. Exercise Interventions Targeting Obesity in Persons With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:109-120. [PMID: 33814889 PMCID: PMC7983638 DOI: 10.46292/sci20-00058] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Spinal cord injury (SCI) results in an array of cardiometabolic complications, with obesity being the most common component risk of cardiometabolic disease (CMD) in this population. Recent Consortium for Spinal Cord Medicine Clinical Practice Guidelines for CMD in SCI recommend physical exercise as a primary treatment strategy for the management of CMD in SCI. However, the high prevalence of obesity in SCI and the pleiotropic nature of this body habitus warrant strategies for tailoring exercise to specifically target obesity. In general, exercise for obesity management should aim primarily to induce a negative energy balance and secondarily to increase the use of fat as a fuel source. In persons with SCI, reductions in the muscle mass that can be recruited during activity limit the capacity for exercise to induce a calorie deficit. Furthermore, the available musculature exhibits a decreased oxidative capacity, limiting the utilization of fat during exercise. These constraints must be considered when designing exercise interventions for obesity management in SCI. Certain forms of exercise have a greater therapeutic potential in this population partly due to impacts on metabolism during recovery from exercise and at rest. In this article, we propose that exercise for obesity in SCI should target large muscle groups and aim to induce hypertrophy to increase total energy expenditure response to training. Furthermore, although carbohydrate reliance will be high during activity, certain forms of exercise might induce meaningful postexercise shifts in the use of fat as a fuel. General activity in this population is important for many components of health, but low energy cost of daily activities and limitations in upper body volitional exercise mean that exercise interventions targeting utilization and hypertrophy of large muscle groups will likely be required for obesity management.
Collapse
Affiliation(s)
- David W. McMillan
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, Florida
- Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Jennifer L. Maher
- Department of Health, University of Bath, Claverton Down, Bath, United Kingdom
| | - Kevin A. Jacobs
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, Florida
| | - Mark S. Nash
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, Florida
| | - David R. Gater
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, Florida
| |
Collapse
|
11
|
Barton TJ, Low DA, Bakker EA, Janssen T, de Groot S, van der Woude L, Thijssen DHJ. Traditional Cardiovascular Risk Factors Strongly Underestimate the 5-Year Occurrence of Cardiovascular Morbidity and Mortality in Spinal Cord Injured Individuals. Arch Phys Med Rehabil 2020; 102:27-34. [PMID: 32861666 DOI: 10.1016/j.apmr.2020.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/26/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore whether traditional models of cardiovascular disease (CVD) risk prediction correctly predict CVD events across a median 5.7-year follow-up period in individuals with spinal cord injury (SCI) and whether adding SCI-related characteristics (ie, lesion level) to the prediction model can improve the prognostic value. DESIGN Retrospective analysis of patient records. SETTING Observation at the start of active rehabilitation of participants in a multicenter cohort study, "Restoration of (Wheelchair) Mobility in SCI Rehabilitation," in the Netherlands. PARTICIPANTS Patients with SCI (N=200) The patients were 74% men, aged 40±14 years, and with an American Spinal Injury Association (ASIA) impairment score of A through D. Forty percent had tetraplegia, and 69% were motor complete. INTERVENTIONS Risk profiling/not applicable. MAIN OUTCOME MEASURES Survival status and cardiovascular morbidity and mortality qwere obtained from medical records. Five-year Framingham Risk Scores (FRS) and the FRS ability to predict events assessed using receiver operating characteristic (ROC) curves with corresponding areas under the curve (AUC) and 95% confidence intervals (CI). Kaplan-Meier curves and the log-rank test were used to assess the difference in clinical outcome between participants with an FRS score lower or higher than the median FRS score for the cohort. SCI-related factors associated with CVD events, ASIA impairment, motor completeness, level of injury, and sports participation before injury were explored using univariate and multivariate Cox proportional hazard regression. RESULTS The median 5-year FRS was 1.36%. Across a median follow-up period of 5.7 years, 39 developed a CVD event, including 10 fatalities. Although the FRS markedly underestimated the true occurrence of CVD events, the Kaplan-Meier curves and the log-rank test showed that the risk ratio for individuals with an FRS score less than the median FRS (eg, low risk) versus a score greater than the median FRS (high risk) was 3.2 (95% CI, 1.6-6.5; P=.001). Moreover, ROC with corresponding AUCs suggests acceptable accuracy of the FRS to identify individuals with increased risk for future CVD events (ROC AUC of 0.71; 95% CI, 0.62-0.82). Adding ASIA impairment (0.74; 95% CI, 0.66-0.82), motor impairment (0.74; 95% CI, 0.66-0.83), level of injury (0.72; 95% CI, 0.63-0.81), or active engagement in sport before injury (0.72; 95% CI, 0.63-0.88) to the FRS did not improve the level of discrimination. CONCLUSIONS Our 5.7-year retrospective study reveals that cardiovascular risk factors and risk models markedly underestimate the true risk for CVD events in individuals with SCI. Nonetheless, these markers successfully distinguish between SCI individuals at high versus low risk for future CVD events. Our data may have future clinical implications, both related to (cutoff values of) CVD risk factors, but also for (earlier) prescription of (non)pharmacologic strategies against CVD in SCI individuals.
Collapse
Affiliation(s)
- Thomas J Barton
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - David A Low
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Esmee A Bakker
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas Janssen
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Center of Human Movement Sciences; Groningen, the Netherlands
| | - Lucas van der Woude
- University of Groningen, University Medical Center Groningen, Center of Human Movement Sciences; Groningen, the Netherlands
| | - Dick H J Thijssen
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| |
Collapse
|
12
|
Yahiro AM, Wingo BC, Kunwor S, Parton J, Ellis AC. Classification of obesity, cardiometabolic risk, and metabolic syndrome in adults with spinal cord injury. J Spinal Cord Med 2020; 43:485-496. [PMID: 30620685 PMCID: PMC7480648 DOI: 10.1080/10790268.2018.1557864] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective: To describe and compare (1) classification of obesity using clinical proxies of body composition that are easily accessible in the outpatient clinic setting, (2) cardiometabolic risk using existing screening tools and staging systems, and (3) the presence of metabolic syndrome (MetS) using four commonly-used definitions in adults with spinal cord injury (SCI). Design: Retrospective chart review Setting: Outpatient Veterans Affairs (VA) SCI Annual Evaluation Clinic Participants: Patients who attended an annual evaluation appointment with demographic, anthropometric, and biochemical data documented in their medical records as part of routine medical care. Outcome measures: Obesity classification (body mass index, waist circumference, ideal body weight percentage), cardiometabolic risk scores (Framingham Risk Score, Cardiometabolic Disease Staging System, Edmonton Obesity Staging System), and MetS classification (using four commonly-used definitions) were described and compared. Results: Of the 155 veterans included in this analysis, 93% were considered "at risk" by at least one of the measurements studied. However, there was considerable variation between the different screening tools. The κ-agreement between various definitions of MetS ranged from fair to moderate. Conclusion: Screening tools that were developed for the non-SCI population produced variable assessments of risk when applied to veterans with SCI. Due to the fair to moderate inter-rater agreement between MetS definitions, it is unknown which definition is superior to identify MetS in the SCI population. An SCI-specific screening tool is needed to accurately classify obesity, cardiometabolic risk, and MetS in order to provide timely education and intervention.
Collapse
Affiliation(s)
- Amy M. Yahiro
- Nutrition and Food Services, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois, USA,Correspondence to: Amy M. Yahiro, Nutrition and Food Services, Edward Hines, Jr. Veterans Affairs Hospital, 5000 South 5th Avenue, Hines, IL60141, USA.
| | - Brooks C. Wingo
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sujit Kunwor
- Department of Information Systems, Statistics, Management Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - Jason Parton
- Department of Information Systems, Statistics, Management Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - Amy C. Ellis
- Department of Human Nutrition and Hospitality Management, University of Alabama, Tuscaloosa, Alabama, USA
| |
Collapse
|
13
|
Lankhorst K, Oerbekke M, van den Berg-Emons R, Takken T, de Groot J. Instruments Measuring Physical Activity in Individuals Who Use a Wheelchair: A Systematic Review of Measurement Properties. Arch Phys Med Rehabil 2019; 101:535-552. [PMID: 31606452 DOI: 10.1016/j.apmr.2019.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/31/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To systematically review the evidence evaluating validity or reliability of self-reported and device-based instruments, to measure physical activity (PA) in individuals who use a wheelchair, and to make recommendations for the selection of PA outcomes tools. DATA SOURCES PubMed, Embase, and CINAHL were systematically searched. STUDY SELECTION Studies reporting measurement properties of instruments to assess PA in individuals who use a wheelchair. DATA EXTRACTION The Consensus-Based Standards for the Selection of Health Status Measurement Instruments checklist was used to assess the methodological quality of the included studies. The measurement properties of instruments assessing PA were examined. DATA SYNTHESIS The search yielded 5341 records, 61 were considered relevant, 21 articles were included. A best evidence synthesis was performed on 9 studies including 4 self-reported instruments and 13 studies including 8 device-based instruments. One study evaluated both self-reported and device-based instruments. The overall methodological quality of all studies ranged from poor to excellent. Variable levels of evidence were found for both the validity and reliability for self-reported instruments and for criterion validity for device-based instruments. CONCLUSIONS The Physical Activity Scale for Individuals with Disabilities (PASIPD) and The Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) seem the most promising self-reported instruments for measuring the intensity of PA. Device-based instruments that can be used for measuring both the intensity and type of PA are the GENEActiv, Actigraph GT3X+, Actiheart, or the Physical Activity Monitor System (PAMS), showing moderate evidence for a positive rating of criterion validity. For measuring the type of PA, the PAMS and VitaMove are suitable, showing both good evidence for a positive rating of criterion validity.
Collapse
Affiliation(s)
- Kristel Lankhorst
- Research Group Lifestyle and Health, Hogeschool Utrecht, University of Applied Sciences, Utrecht; Shared Utrecht Pediatric Exercise Laboratory, Utrecht.
| | | | - Rita van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus Medical Center, University Medical Centre Rotterdam
| | - Tim Takken
- University Medical Center Utrecht, Wilhelmina Children's Hospital Utrecht; Shared Utrecht Pediatric Exercise Laboratory, Utrecht
| | - Janke de Groot
- Research Group Lifestyle and Health, Hogeschool Utrecht, University of Applied Sciences, Utrecht; Shared Utrecht Pediatric Exercise Laboratory, Utrecht; Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| |
Collapse
|
14
|
Nash MS, Groah SL, Gater DR, Dyson-Hudson TA, Lieberman JA, Myers J, Sabharwal S, Taylor AJ. Identification and Management of Cardiometabolic Risk after Spinal Cord Injury. J Spinal Cord Med 2019; 42:643-677. [PMID: 31180274 PMCID: PMC6758611 DOI: 10.1080/10790268.2018.1511401] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
15
|
A cross-sectional comparison between cardiorespiratory fitness, level of lesion and red blood cell distribution width in adults with chronic spinal cord injury. J Sci Med Sport 2019; 23:106-111. [PMID: 31558360 DOI: 10.1016/j.jsams.2019.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess; (1) differences in red blood cell distribution width between individuals with chronic (>1year), motor-complete cervical (n=21), upper-thoracic (n=27) and thoracolumbar (n=15) spinal cord injury and, (2) associations between red blood cell distribution width and cardiorespiratory fitness. DESIGN Prospective multi-center, cross-sectional study. METHODS Peak oxygen uptake was determined using an upper-body arm-crank exercise test to volitional exhaustion and red blood cell distribution width was measured using an automated hematology system. RESULTS There were significant (p<0.009) differences between groups classified by level of injury in absolute and relative peak oxygen uptake, peak power output and red blood cell distribution width. A significant (p<0.001) large negative association (r = -0.524) was found between relative peak oxygen uptake and red blood cell distribution width. Unbiased recursive partitioning, while revealing study site specific differences in red blood cell distribution width, identified homogenous subgroups based specifically on cardiorespiratory fitness irrespective of additional demographic and injury characteristics. CONCLUSION The strong negative association between cardiorespiratory fitness and red blood cell distribution width in individuals with paraplegia parallel those previously observed in non-disabled individuals. Higher red blood cell distribution width values are an independent risk factor for increased cardiovascular mortality, heart failure, and coronary heart disease and may reflect several underlying exacerbated metabolic responses such as oxidative stress and systemic inflammation. These data emphasize the importance of maintaining a high aerobic capacity following spinal cord injury.
Collapse
|
16
|
Bigford GE, Darr AJ, Bracchi-Ricard VC, Gao H, Nash MS, Bethea JR. Effects of ursolic acid on sub-lesional muscle pathology in a contusion model of spinal cord injury. PLoS One 2018; 13:e0203042. [PMID: 30157245 PMCID: PMC6114926 DOI: 10.1371/journal.pone.0203042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/14/2018] [Indexed: 12/25/2022] Open
Abstract
Spinal Cord Injury (SCI) results in severe sub-lesional muscle atrophy and fiber type transformation from slow oxidative to fast glycolytic, both contributing to functional deficits and maladaptive metabolic profiles. Therapeutic countermeasures have had limited success and muscle-related pathology remains a clinical priority. mTOR signaling is known to play a critical role in skeletal muscle growth and metabolism, and signal integration of anabolic and catabolic pathways. Recent studies show that the natural compound ursolic acid (UA) enhances mTOR signaling intermediates, independently inhibiting atrophy and inducing hypertrophy. Here, we examine the effects of UA treatment on sub-lesional muscle mTOR signaling, catabolic genes, and functional deficits following severe SCI in mice. We observe that UA treatment significantly attenuates SCI induced decreases in activated forms of mTOR, and signaling intermediates PI3K, AKT, and S6K, and the upregulation of catabolic genes including FOXO1, MAFbx, MURF-1, and PSMD11. In addition, UA treatment improves SCI induced deficits in body and sub-lesional muscle mass, as well as functional outcomes related to muscle function, motor coordination, and strength. These findings provide evidence that UA treatment may be a potential therapeutic strategy to improve muscle-specific pathological consequences of SCI.
Collapse
Affiliation(s)
- Gregory E. Bigford
- The Miami Project to Cure Paralysis, Miami, Florida, United States of America
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Andrew J. Darr
- Department of Health Sciences Education, University of Illinois College of Medicine at Peoria, Peoria, Illinois, United States of America
| | | | - Han Gao
- The Miami Project to Cure Paralysis, Miami, Florida, United States of America
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Mark S. Nash
- The Miami Project to Cure Paralysis, Miami, Florida, United States of America
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - John R. Bethea
- Department of Biology, Drexel University, Philadelphia, Pennsylvania, United States of America
| |
Collapse
|
17
|
Maher JL, McMillan DW, Nash MS. Exercise and Health-Related Risks of Physical Deconditioning After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 23:175-187. [PMID: 29339894 DOI: 10.1310/sci2303-175] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A sedentary lifestyle occurring soon after spinal cord injury (SCI) may be in contrast to a preinjury history of active physical engagement and is thereafter associated with profound physical deconditioning sustained throughout the lifespan. This physical deconditioning contributes in varying degrees to lifelong medical complications, including accelerated cardiovascular disease, insulin resistance, osteopenia, and visceral obesity. Unlike persons without disability for whom exercise is readily available and easily accomplished, exercise options for persons with SCI are more limited. Depending on the level of injury, the metabolic responses to acute exercise may also be less robust than those accompanying exercise in persons without disability, the training benefits more difficult to achieve, and the risks of ill-considered exercise both greater and potentially irreversible. For exercise to ultimately promote benefit and not impose additional impairment, an understanding of exercise opportunities and risks if exercise is undertaken by those with SCI is important. The following monograph will thus address common medical challenges experienced by persons with SCI and typical modes and benefits of voluntary exercise conditioning.
Collapse
Affiliation(s)
- Jennifer L Maher
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - David W McMillan
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.,Department of Kinesiology and Sports Sciences, University of Miami, Coral Gables, Florida
| | - Mark S Nash
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.,Departments of Neurological Surgery and Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
18
|
Bigford G, Nash MS. Nutritional Health Considerations for Persons with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 23:188-206. [PMID: 29339895 DOI: 10.1310/sci2303-188] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic spinal cord injury (SCI) often results in morbidity and mortality due to all-cause cardiovascular disease (CVD) and comorbid endocrine disorders. Several component risk factors for CVD, described as the cardiometabolic syndrome (CMS), are prevalent in SCI, with the individual risks of obesity and insulin resistance known to advance the disease prognosis to a greater extent than other established risks. Notably, adiposity and insulin resistance are attributed in large part to a commonly observed maladaptive dietary/nutritional profile. Although there are no evidence-based nutritional guidelines to address the CMS risk in SCI, contemporary treatment strategies advocate more comprehensive lifestyle management that includes sustained nutritional guidance as a necessary component for overall health management. This monograph describes factors in SCI that contribute to CMS risks, the current nutritional profile and its contribution to CMS risks, and effective treatment strategies including the adaptability of the Diabetes Prevention Program (DPP) to SCI. Establishing appropriate nutritional guidelines and recommendations will play an important role in addressing the CMS risks in SCI and preserving optimal long-term health.
Collapse
Affiliation(s)
- Gregory Bigford
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida.,The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Mark S Nash
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida.,Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
19
|
Nash MS, Groah SL, Gater DR, Dyson-Hudson TA, Lieberman JA, Myers J, Sabharwal S, Taylor AJ. Identification and Management of Cardiometabolic Risk after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2018; 24:379-423. [PMID: 30459501 PMCID: PMC6241225 DOI: 10.1310/sci2404-379] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mark S Nash
- Departments of Neurological Surgery and Physical Medicine & Rehabilitation, Applied Physiology Research Laboratory, The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Suzanne L Groah
- Paralysis Rehabilitation and Recovery Program, Spinal Cord Injury Research, MedStar National Rehabilitation Hospital, Washington, DC
- Rehabilitation Medicine, Georgetown University Hospital, Washington, DC
| | - David R Gater
- Physical Medicine and Rehabilitation, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Trevor A Dyson-Hudson
- Spinal Injury Research and Outcomes Assessment Research, Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jesse A Lieberman
- Carolinas Rehabilitation and Carolinas Medical Center, Charlotte, North Carolina
| | - Jonathan Myers
- Department of Medicine, Stanford University, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
| | - Sunil Sabharwal
- VA Boston Health Care System, Boston, Massachusetts
- VA Spinal Cord Injuries and Disorders System of Care, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Allen J Taylor
- MedStar Georgetown University Hospital, MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC
- Uniformed University of the Health Sciences, Bethesda, Maryland
- Georgetown University, Washington, DC
| |
Collapse
|
20
|
Koyuncu E, Nakipoğlu Yüzer GF, Yenigün D, Özgirgin N. The analysis of serum lipid levels in patients with spinal cord injury. J Spinal Cord Med 2017; 40:567-572. [PMID: 27735233 PMCID: PMC5815153 DOI: 10.1080/10790268.2016.1228286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES The purposes of this investigation were to evaluate the serum lipid profile among a broad sample of patients with spinal cord injury (SCI), examining the impact of disease duration, lesion level, lesion grade and functional activity level on serum lipid levels of patients with SCI. SETTING Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Turkey. METHODS Serum lipid profiles of 269 participants with SCI were analyzed and correlated to disease duration, lesion level, lesion grade and ambulation status. RESULTS Total cholesterol (TC) was higher than normal in 21.2%, low density lipoprotein cholesterol in 24.4%, and triglycerides levels in 31% of the patients. The high density lipoprotein cholesterol (HDL-c) level was found to be lower than 40 mg/dl in 79.5% of the patients, TC/HDL-c ratio was 4.5 and above in 65.7% of the patients in our study. TC/HDL-c ratio was significantly higher in patients with SCI with a disease duration of 0-12 months than the group with a longer disease duration (P = 0.009). TC/HDL-c ratio was significantly higher in patients who could not be community ambulated than the patients who were community ambulated (P = 0.005). HDL-c levels in patients with motor complete SCI were significantly lower than patients with motor incomplete SCI (P = 0.028). CONCLUSION Dyslipidemia is observed in a large number of patients with SCI. The risk of dyslipidemia was seen to have increased in motor complete SCI patients, in patients who can not be community ambulated and whose disease duration is between 0 to 12 months.
Collapse
Affiliation(s)
- Engin Koyuncu
- Correspondence to: Dr. Engin Koyuncu, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Türkocağı Sokak, No:3, Sıhhiye, Altındağ, Ankara, Turkey.
| | | | | | | |
Collapse
|
21
|
Comorbidity and physical activity in people with paraplegia: a descriptive cross-sectional study. Spinal Cord 2017; 56:52-56. [PMID: 28762381 DOI: 10.1038/sc.2017.90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Descriptive cross-sectional study. SETTING The study was conducted in the Spinal Cord Injury Unit of the University Vall d'Hebron Hospital and in the Physical Education and Sports Department of the University of Valencia. OBJECTIVES The aim of this study was to quantify the presence of comorbidities in spinal cord injury (SCI) subjects who did or did not perform regular physical activity (PA) and to identify the relationship between PA and the level of comorbidity. METHODS The sample consisted of patients with complete motor SCI (T2-T12), who were fitted with an accelerometer attached to the non-dominant wrist for a period of 1 week. The clinical and blood analytic variables were selected by an expert panel. RESULTS In the exploratory analysis, we have found differences in the total number of pathologies between active and inactive patients, with fewer total pathologies in the active patient group. An association was found between the PA level and diabetes mellitus (; P=0.047; φ=0.25). We also observed an association between the cardioprotector level of high-density lipoprotein (HDL)-cholesterol and PA level (; P=0.057; Φ0.24). CONCLUSIONS Our results suggest that patients considered active showed lower total comorbidity than inactive patients and higher protection levels against developing cardiovascular comorbidity.
Collapse
|
22
|
Methods for classifying obesity in spinal cord injury: a review. Spinal Cord 2017; 55:812-817. [PMID: 28695902 DOI: 10.1038/sc.2017.79] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 01/26/2023]
Abstract
STUDY DESIGN Narrative review. OBJECTIVES Review methods used to measure and classify obesity in individuals with spinal cord injuries (SCI). Outline the strengths and weaknesses of each method used to measure obesity in individuals with SCI. SETTING International. METHODS PubMed was used to identify articles before 2016. Search terms ('obesity' or 'weight status' and 'spinal cord injury'). Filters: adults, English and human. Studies were retained that (1) included participants, 18 years or older, with SCI; (2) took place in inpatient, outpatient or community-based settings and (3) measured obesity status. Unique methods for classifying individuals with SCI as obese were identified and examples are presented. RESULTS Methods identified for classifying obesity were as follows: World Health Organization body mass index (BMI) cutoff⩾30 kg m-2, BMI cutoff ⩾25-29 kg m-2, and SCI-specific BMI cutoff ⩾22 kg m-2, waist circumference cutoff (women >102 cm, men >88 cm), percent body fat cutoffs ⩾25% using bioelectrical impedance analysis and dual-energy X-ray absorptiometry, computerized tomography scan visceral fat area ⩾100 cm2 and percentage of ideal body weight. CONCLUSIONS BMI is the most widely used measure of obesity in the SCI literature. Although some studies identified alternative cutoffs or other metrics, there is no standardized obesity classification in SCI. However, research is needed to determine and validate obesity classification specific to SCI due to physiological changes that occur following injury. We recommend that researchers and clinicians proceed with caution and use methodology based on the purpose of measurement.
Collapse
|
23
|
A lifestyle intervention program for successfully addressing major cardiometabolic risks in persons with SCI: a three-subject case series. Spinal Cord Ser Cases 2017; 3:17007. [PMID: 28382218 DOI: 10.1038/scsandc.2017.7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/14/2016] [Accepted: 01/13/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION This study is a prospective case series analyzing the effects of a comprehensive lifestyle intervention program in three patients with chronic paraplegia having major risks for the cardiometabolic syndrome (CMS). CASE PRESENTATION Individuals underwent an intense 6-month program of circuit resistance exercise, nutrition using a Mediterranean diet and behavioral support, followed by a 6-month extension (maintenance) phase involving minimal support. The primary goal was a 7% reduction of body mass. Other outcomes analyzed insulin resistance using the HOMA-IR model, and plasma levels of fasting triglycerides and high-density lipoprotein cholesterol. All participants achieved the goal for 7% reduction of body mass and maintained the loss after the MP. Improvements were observed in 2/3 subjects for HOMA-IR and high-density lipoprotein cholesterol. All participants improved their risk for plasma triglycerides. DISCUSSION We conclude, in a three-person case series of persons with chronic paraplegia, a lifestyle intervention program involving circuit resistance training, a calorie-restrictive Mediterranean-style diet and behavioral support, results in clinically significant loss of body mass and effectively reduced component risks for CMS and diabetes. These results were for the most part maintained after a 6-month MP involving minimal supervision.
Collapse
|
24
|
Abstract
OBJECTIVE To describe the initial benefits of a structured group exercise program on exercise frequency and intensity, perceived health, pain, mood, and television watching habits. DESIGN Pre-test/post-test. PARTICIPANTS/METHODS Eighty-nine persons with SCI participated voluntarily in a no-cost, twice weekly physical therapy group exercise class over 3 months. Forty-five persons completed pre- and post-participation interviews on exercise frequency and intensity, perceived health, pain, mood, sleep, and television watching habits. RESULTS Mean participant age of the respondents was 43.82 years. 49% had AIS C or D injuries, 24% had AIS A,B paraplegia, 9% had AIS A,B C1-C4 and 18% had AIS A,B C5-C8. 75.6% of participants were male and 84.4% had a traumatic etiology as the cause of their SCI. There was a significant improvement in days of strenuous and moderate exercise as well as health state. There was an average decrease in pain scores, depression scores, number of hours spent watching television, and days/week of mild exercise. CONCLUSION Participation in structured, small group exercise as a component of a wellness program after SCI shows promise for improving regular exercise participation and health state, but benefits may also occur across other areas of health and function including mood, pain, and hours spent watching television. Further follow-up is needed to determine whether improvements can be maintained after program completion and across all neurological levels.
Collapse
Affiliation(s)
- Deborah A. Crane
- Correspondence to: Deborah A. Crane, Department of Rehabilitation Medicine, University of Washington/Harborview Medical Center, 325 9th Avenue, Box 359740, Seattle, WA 98104, USA.
| | | | | |
Collapse
|
25
|
Vitamin D and spinal cord injury: should we care? Spinal Cord 2016; 54:1060-1075. [PMID: 27645263 DOI: 10.1038/sc.2016.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/26/2016] [Accepted: 08/11/2016] [Indexed: 12/18/2022]
Abstract
STUDY DESIGN Narrative review. OBJECTIVES This review provides an overview of the etiological factors and consequences of vitamin D insufficiency in relation to spinal cord injury (SCI) as well as important considerations for vitamin D supplementation. SETTING Montreal, Canada. METHODS Literature search. RESULTS Vitamin D insufficiency is common in SCI individuals owing to the presence of many contributing factors including limited sun exposure and intake, use of medication and endocrine perturbations. Although there are several biological plausible mechanisms by which vitamin D may act upon musculoskeletal and cardiometabolic health, the impact of vitamin D insufficiency on such systems remains ill defined in SCI. In the absence of guidelines for the management of vitamin D insufficiency in this high-risk population and in an attempt to provide clinical guidance, considerations for vitamin D supplementation such as the type of vitamin D, dosing regimens and toxicity are discussed and tentative recommendations suggested with particular reference to issues faced by SCI patients. CONCLUSION Although high rates of vitamin D insufficiency are encountered in SCI individuals, its consequences and the amount of vitamin D required to prevent insufficiency are still unknown, indicating a need for more intervention studies with well-defined outcome measures. Routine screening and monitoring of vitamin D as well as treatment of suboptimal status should be instituted in both acute and chronic setting. The close interactions between vitamin D and related bone minerals should be kept in mind when supplementing SCI individuals, and practices should be individualized with clinical conditions.
Collapse
|
26
|
de Groot S, Adriaansen JJ, Tepper M, Snoek GJ, van der Woude LHV, Post MWM. Metabolic syndrome in people with a long-standing spinal cord injury: associations with physical activity and capacity. Appl Physiol Nutr Metab 2016; 41:1190-1196. [PMID: 27806636 DOI: 10.1139/apnm-2016-0269] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigated (i) the prevalence of the metabolic syndrome (MetS) in people with a long-standing spinal cord injury (SCI); (ii) whether personal or lesion characteristics are determinants of the MetS; and (iii) the association with physical activity or peak aerobic capacity on the MetS. In a cross-sectional study, persons with SCI (N = 223; time since injury of ≥10 years) were tested. The individual components of the MetS were assessed together with the physical activity measured by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), while peak aerobic capacity was tested during a graded wheelchair exercise test on a treadmill. Thirty-nine percent of the participants had MetS. In a multivariate logistic regression analyses and after performing a backward regression analysis, only age and education were significant determinants of the MetS. A 10-year increase in age leads to a 1.5 times more chance to have the MetS. Furthermore, people with a low education will multiply the relative risk of MetS compared with people with high education by almost 2. With and without correcting for confounders, no significant relationship was found between PASIPD or peak aerobic capacity and the MetS. It can be concluded that the prevalence of the MetS is high (39%) in people with a long-standing SCI but is comparable to the general Dutch population. Older people and those with a lower education level are most at risk for the MetS. Physical activity and peak aerobic fitness were not related to the MetS in this group with a long-standing SCI.
Collapse
Affiliation(s)
- Sonja de Groot
- a Amsterdam Rehabilitation Research Center/Reade, PO box 58271, 1040 HG Amsterdam, the Netherlands.,b University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, gebouw 3215. Groningen 9713 AV Groningen, the Netherlands
| | - Jacinthe J Adriaansen
- c Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Rembrandtkade 10 3583 TM Utrecht, the Netherlands
| | - Marga Tepper
- d Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1. Fonteinstraat 4 9713 GZ Groningen, the Netherlands
| | - Govert J Snoek
- e Rehabilitation Center Roessingh, Enschede, the Netherlands
| | - Lucas H V van der Woude
- b University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, gebouw 3215. Groningen 9713 AV Groningen, the Netherlands.,d Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1. Fonteinstraat 4 9713 GZ Groningen, the Netherlands
| | - Marcel W M Post
- c Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Rembrandtkade 10 3583 TM Utrecht, the Netherlands.,d Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1. Fonteinstraat 4 9713 GZ Groningen, the Netherlands
| |
Collapse
|
27
|
Kressler J, Cowan RE, Bigford GE, Nash MS. Reducing cardiometabolic disease in spinal cord injury. Phys Med Rehabil Clin N Am 2015; 25:573-604, viii. [PMID: 25064789 DOI: 10.1016/j.pmr.2014.04.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Accelerated cardiometabolic disease is a serious health hazard after spinal cord injuries (SCI). Lifestyle intervention with diet and exercise remains the cornerstone of effective cardiometabolic syndrome treatment. Behavioral approaches enhance compliance and benefits derived from both diet and exercise interventions and are necessary to assure that persons with SCI profit from intervention. Multitherapy strategies will likely be needed to control challenging component risks, such as gain in body mass, which has far reaching implications for maintenance of daily function as well as health.
Collapse
Affiliation(s)
- Jochen Kressler
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, 1475 North West 12th Avenue, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 North West 14th Terrace, Lois Pope LIFE Center, Miami, FL 33136, USA
| | - Rachel E Cowan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, 1475 North West 12th Avenue, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 North West 14th Terrace, Lois Pope LIFE Center, Miami, FL 33136, USA
| | - Gregory E Bigford
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, 1475 North West 12th Avenue, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 North West 14th Terrace, Lois Pope LIFE Center, Miami, FL 33136, USA
| | - Mark S Nash
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, 1475 North West 12th Avenue, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 North West 14th Terrace, Lois Pope LIFE Center, Miami, FL 33136, USA; Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, 1500 North West 12th Avenue, Suite 1409, Miami, FL 33136, USA.
| |
Collapse
|
28
|
Maitland Schladen M, Groah SL. State of the science on cardiometabolic risk after spinal cord injury: recap of the 2013 Asia pre-conference on cardiometabolic disease. Top Spinal Cord Inj Rehabil 2014; 20:105-12. [PMID: 25477732 DOI: 10.1310/sci2002-105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manon Maitland Schladen
- MedStar National Rehabilitation Hospital , Washington, DC ; MedStar Health Research Institute , Washington, DC ; District of Columbia Veterans Affairs Medical Center , Washington, DC
| | - Suzanne L Groah
- MedStar National Rehabilitation Hospital , Washington, DC ; MedStar Georgetown University Hospital , Washington, DC
| |
Collapse
|
29
|
Krause JS, DiPiro ND, Saunders LL, Newman SD, Banik NL, Park S. Allostatic load and spinal cord injury: review of existing research and preliminary data. Top Spinal Cord Inj Rehabil 2014; 20:137-46. [PMID: 25477736 DOI: 10.1310/sci2002-137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To introduce allostatic load (AL) as a framework for measuring stress-related outcomes after spinal cord injury (SCI) by identifying the number and nature of biomarkers investigated in existing studies and by generating preliminary data on AL in 30 persons with traumatic SCI. METHODS This systematic review and pilot study were conducted at a medical university in the southeastern United States. A review of literature published between 1993 and 2012 identified studies using 2 or more of 5 classes of AL biomarkers. We then collected data on 11 biomarkers (n = 30) from self-selected participants using physical exams and blood and urine specimen collection. These included waist to hip ratio, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, dihydroepiandrosterone, glycosylated hemoglobin, C-reactive protein, interleukin-6, and cortisol, norepinephrine, and epinephrine normalized by 12-hour creatinine. RESULTS We were unable to identify any studies investigating AL biomarkers from each of the 5 areas or any studies specifically proposing to investigate AL. AL scores were relatively low, with metabolic indicators being the most elevated and neuroendocrine the least elevated. CONCLUSIONS AL is a promising, yet underutilized, construct that may be feasibly assessed after SCI.
Collapse
Affiliation(s)
- James S Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina
| | - Nicole D DiPiro
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina
| | - Lee L Saunders
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina
| | - Susan D Newman
- Department of Nursing, College of Nursing, Medical University of South Carolina , Charleston, South Carolina
| | - Narendra L Banik
- Department of Neurosciences, College of Medicine, Medical University of South Carolina , Charleston, South Carolina
| | - Sookyoung Park
- Department of Neurosciences, College of Medicine, Medical University of South Carolina , Charleston, South Carolina
| |
Collapse
|
30
|
Lai YJ, Lin CL, Chang YJ, Lin MC, Lee ST, Sung FC, Lee WY, Kao CH. Spinal cord injury increases the risk of type 2 diabetes: a population-based cohort study. Spine J 2014; 14:1957-64. [PMID: 24361350 DOI: 10.1016/j.spinee.2013.12.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 11/22/2013] [Accepted: 12/13/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies on the risk and prevalence of diabetes among spinal cord injury (SCI) patients are limited and controversial. PURPOSE To compare the risk and incidence rate (IR) of Type 2 diabetes in SCI and non-SCI patients. STUDY DESIGN This is a population-based retrospective cohort study. PATIENT SAMPLE Data from Taiwan's National Health Insurance Research Database for the period 1997 to 2010 were analyzed. Patients aged 20 years and older newly identified with SCIs during this period were included in the SCI cohort. A non-SCI comparison cohort was randomly selected from National Health Insurance beneficiaries and matched with the SCI cohort based on age, sex, and index date. OUTCOME MEASURES Both cohorts were followed until the first of the following occurred: the diagnosis of Type 2 diabetes (International Classification of Disease, Ninth Revision, Clinical Modification codes 250), withdrawal from the insurance system, the end of 2010, or death. METHODS A Cox proportional hazards regression analysis was used to estimate the risk of developing diabetes. RESULTS Taiwan possesses an older SCI population, with a mean age of 51.6 years. The IR for diabetes in patients with and without SCIs was 22.1 per 10,000 person-years and 17.2 per 10,000 person-years, respectively. The adjusted hazard ratio (HR) for diabetes was 1.33 times higher in patients with SCIs than in those without SCIs. In patients with SCIs, men (adjusted HR=1.23, 95% confidence interval (CI)=1.04-1.44), older people (adjusted HR=4.26 in patients older than 65 years, 95% CI=3.16-5.74), patients with comorbidity (adjusted HR=1.36, 95% CI=1.14-1.62), and patients with a complete thoracic SCI (T-spine injury) (adjusted HR=2.13, 95% CI=0.95-4.79) were more likely to be diagnosed with diabetes than other patient subgroups. CONCLUSIONS Our findings may facilitate the prioritizing of preventive health strategies and planning of long-term care for SCI patients.
Collapse
Affiliation(s)
- Yun-Ju Lai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, No.1, Rongguang Rd, Puli Township, Nantou County 545, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan
| | - Yen-Jung Chang
- Management Office for Health Data, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, No.1, Yida Rd, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan
| | - Shih-Tan Lee
- Department of Family Medicine, Puli Branch of Taichung Veterans General Hospital, No.1, Rongguang Rd, Puli Township, Nantou County 545, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan; Department of Public Health, China Medical University, No. 2, Yuh-Der Rd, Taichung 404, Taiwan
| | - Wen-Yuan Lee
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Rd, Taichung 404, Taiwan; China Medical University Hospital Taipei Branch, No. 360, Sec. 2, Neihu Rd. Neihu District, Taipei, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Rd, Taichung 404, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan.
| |
Collapse
|
31
|
Sisto SA, Evans N. Activity and Fitness in Spinal Cord Injury: Review and Update. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0057-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
32
|
Driussi C, Ius A, Bizzarini E, Antonini-Canterin F, d'Andrea A, Bossone E, Vriz O. Structural and functional left ventricular impairment in subjects with chronic spinal cord injury and no overt cardiovascular disease. J Spinal Cord Med 2014; 37:85-92. [PMID: 24456485 PMCID: PMC4066555 DOI: 10.1179/2045772313y.0000000161] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
CONTEXT Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in subjects with long-term spinal cord injury (SCI). More specific recommendations for CVD prevention in this population are needed. METHODS One hundred thirty male subjects (47 subjects with SCI and 83 able-bodied persons (ABPs), mean age 43.89 ± 1.9 and 45.44 ± 12.2 years; P = 0.48) underwent transthoracic echocardiography (TTE). The effects of age, weight, mean arterial pressure (MAP) and level of physical training on cardiac adaptations were evaluated through multiple regression analysis. RESULTS In subjects with SCI, TTE revealed increased wall thickness (P < 0.05), lower E wave, E/A ratio and early diastolic myocardial relaxation velocity on Tissue Doppler Imaging (TDI) (P < 0.05) and higher systolic myocardial contraction velocity on TDI (0.10 ± 0.02 vs. 0.09 ± 0.02 m/seconds, P = 0.002) and peak systolic pressure to end-systolic volume ratio (3.62 ± 1.39 vs. 2.82 ± 0.90, P < 0.001) compared with ABPs. Aortic diameters were larger in subjects with SCI than ABPs. Differences remained statistically significant even after adjustment for age, weight, MAP, and level of physical training. Weight and age were found to be independent variables that substantially affected left ventricular structure and function in subjects with SCI. CONCLUSIONS Subjects with post-traumatic chronic SCI and no overt cardiovascular risk factors, exhibit initial left ventricular remodeling (as assessed by TTE) compared with ABPs. Lifestyle modifications, including regular physical exercise and weight control, should be implemented in all subjects with SCI, even at a very early stage, in order to reduce cardiovascular risk and prevent the development of CVD.
Collapse
Affiliation(s)
- Caterina Driussi
- Correspondence to: Caterina Driussi, Department of Emergency and Cardiology, San Antonio Community Hospital, Via Trento-Trieste, 33038 San Daniele del Friuli, Udine, Italy.
| | - Arianna Ius
- Cardiology and Emergency Department, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | | | | | | | - Eduardo Bossone
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Olga Vriz
- Cardiology and Emergency Department, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| |
Collapse
|
33
|
Lieberman J, Goff D, Hammond F, Schreiner P, James Norton H, Dulin M, Zhou X, Steffen L. Dietary intake relative to cardiovascular disease risk factors in individuals with chronic spinal cord injury: a pilot study. Top Spinal Cord Inj Rehabil 2014; 20:127-36. [PMID: 25477735 PMCID: PMC4252172 DOI: 10.1310/sci2002-127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The relationship between cardiovascular disease (CVD) risk factors and dietary intake is unknown among individuals with spinal cord injury (SCI). OBJECTIVE To investigate the relationship between consumption of selected food groups (dairy, whole grains, fruits, vegetables, and meat) and CVD risk factors in individuals with chronic SCI. METHODS A cross-sectional substudy of individuals with SCI to assess CVD risk factors and dietary intake in comparison with age-, gender-, and race-matched able-bodied individuals enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary history, blood pressure, waist circumference (WC), fasting blood glucose, high-sensitivity C-reactive protein (hs-CRP), lipids, glucose, and insulin data were collected from 100 SCI participants who were 38 to 55 years old with SCI >1 year and compared to 100 matched control participants from the CARDIA study. RESULTS Statistically significant differences between SCI and CARDIA participants were identified in WC (39.2 vs 36.2 in.; P < .001) and high-density lipoprotein cholesterol (HDL-C; 39.2 vs 47.5 mg/dL; P < .001). Blood pressure, total cholesterol, triglycerides, glucose, insulin, and hs-CRP were similar between SCI and CARDIA participants. No significant relation between CVD risk factors and selected food groups was seen in the SCI participants. CONCLUSION SCI participants had adverse WC and HDL-C compared to controls. This study did not identify a relationship between consumption of selected food groups and CVD risk factors.
Collapse
Affiliation(s)
- Jesse Lieberman
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, North Carolina
| | - David Goff
- Colorado School of Public Health, Denver, Colorado
| | - Flora Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana
| | - Pamela Schreiner
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - H. James Norton
- Department of Biostatistics, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael Dulin
- Department of Family Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Xia Zhou
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - Lyn Steffen
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| |
Collapse
|
34
|
Serum lipid concentrations among persons with spinal cord injury - a systematic review and meta-analysis of the literature. Atherosclerosis 2013; 232:305-12. [PMID: 24468143 DOI: 10.1016/j.atherosclerosis.2013.11.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 10/24/2013] [Accepted: 11/05/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND Lipid optimization comprises a therapeutic cornerstone of primary and secondary cardiovascular disease prevention. This systematic review and meta-analysis sought to clarify patterns of lipid profiles in spinal cord injury (SCI) patients compared to able-bodied individuals as well as among subgroups of SCI patients stratified by sex, activity level, race, and level of injury. METHODS Searches were conducted in PubMed, CINAHL, PsycINFO, and EMBASE. The initial literature search broadly identified peer-reviewed studies that examined cardiovascular risk factors in SCI. A total of 50 studies were ultimately identified that focused on lipid levels in SCI. Demographic data (including subject age, duration of injury, height, weight, and body mass index [BMI]) and lipid values were extracted for able-bodied individuals and subjects with SCI. Statistical analyses included t-testing and analysis of variance (ANOVA). RESULTS Compared with controls, individuals with SCI had significantly lower total cholesterol (TC) (183.4 mg/dL versus 194.9 mg/dL, p = 0.019) and high-density lipoprotein cholesterol (HDL-C) (41.0 mg/dL versus 49.6 mg/dL, p < 0.001) and higher TC/HDL-C ratios (4.5 versus 4.0, p = 0.002), though no significant differences were found for triglyceride (TG) and non-HDL-C values. CONCLUSIONS SCI represents an increasingly common chronic condition, now secondarily characterized by heightened CVD risk potentially in part due to unique lipid profiles characterized primarily by low HDL-C and an increased TC/HDL-C ratio. As other at-risk patient populations have received increased acknowledgment with more stringent lipid panel screening at earlier ages and increased frequency, we would propose that the same be implemented for the SCI population until more-specific CVD risk stratification guidelines are established for this population.
Collapse
|
35
|
Neuroendocrine and cardiac metabolic dysfunction and NLRP3 inflammasome activation in adipose tissue and pancreas following chronic spinal cord injury in the mouse. ASN Neuro 2013; 5:243-55. [PMID: 23924318 PMCID: PMC3789215 DOI: 10.1042/an20130021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
CVD (cardiovascular disease) represents a leading cause of mortality in chronic SCI (spinal cord injury). Several component risk factors are observed in SCI; however, the underlying mechanisms that contribute to these risks have not been defined. Central and peripheral chronic inflammation is associated with metabolic dysfunction and CVD, including adipokine regulation of neuroendocrine and cardiac function and inflammatory processes initiated by the innate immune response. We use female C57 Bl/6 mice to examine neuroendocrine, cardiac, adipose and pancreatic signaling related to inflammation and metabolic dysfunction in response to experimentally induced chronic SCI. Using immuno-histochemical, -precipitation, and -blotting analysis, we show decreased POMC (proopiomelanocortin) and increased NPY (neuropeptide-Y) expression in the hypothalamic ARC (arcuate nucleus) and PVN (paraventricular nucleus), 1-month post-SCI. Long-form leptin receptor (Ob-Rb), JAK2 (Janus kinase)/STAT3 (signal transducer and activator of transcription 3)/p38 and RhoA/ROCK (Rho-associated kinase) signaling is significantly increased in the heart tissue post-SCI, and we observe the formation and activation of the NLRP3 (NOD-like receptor family, pyrin domain containing 3) inflammasome in VAT (visceral adipose tissue) and pancreas post-SCI. These data demonstrate neuroendocrine signaling peptide alterations, associated with central inflammation and metabolic dysfunction post-SCI, and provide evidence for the peripheral activation of signaling mechanisms involved in cardiac, VAT and pancreatic inflammation and metabolic dysfunction post-SCI. Further understanding of biological mechanisms contributing to SCI-related inflammatory processes and metabolic dysfunction associated with CVD pathology may help to direct therapeutic and rehabilitation countermeasures.
Collapse
|
36
|
Libin A, Tinsley EA, Nash MS, Mendez AJ, Burns P, Elrod M, Hamm LF, Groah SL. Cardiometabolic risk clustering in spinal cord injury: results of exploratory factor analysis. Top Spinal Cord Inj Rehabil 2013; 19:183-94. [PMID: 23960702 PMCID: PMC3743968 DOI: 10.1310/sci1903-183] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Evidence suggests an elevated prevalence of cardiometabolic risks among persons with spinal cord injury (SCI); however, the unique clustering of risk factors in this population has not been fully explored. OBJECTIVE The purpose of this study was to describe unique clustering of cardiometabolic risk factors differentiated by level of injury. METHODS One hundred twenty-one subjects (mean 37 ± 12 years; range, 18-73) with chronic C5 to T12 motor complete SCI were studied. Assessments included medical histories, anthropometrics and blood pressure, and fasting serum lipids, glucose, insulin, and hemoglobin A1c (HbA1c). RESULTS The most common cardiometabolic risk factors were overweight/obesity, high levels of low-density lipoprotein (LDL-C), and low levels of high-density lipoprotein (HDL-C). Risk clustering was found in 76.9% of the population. Exploratory principal component factor analysis using varimax rotation revealed a 3-factor model in persons with paraplegia (65.4% variance) and a 4-factor solution in persons with tetraplegia (73.3% variance). The differences between groups were emphasized by the varied composition of the extracted factors: Lipid Profile A (total cholesterol [TC] and LDL-C), Body Mass-Hypertension Profile (body mass index [BMI], systolic blood pressure [SBP], and fasting insulin [FI]); Glycemic Profile (fasting glucose and HbA1c), and Lipid Profile B (TG and HDL-C). BMI and SBP formed a separate factor only in persons with tetraplegia. CONCLUSIONS Although the majority of the population with SCI has risk clustering, the composition of the risk clusters may be dependent on level of injury, based on a factor analysis group comparison. This is clinically plausible and relevant as tetraplegics tend to be hypo- to normotensive and more sedentary, resulting in lower HDL-C and a greater propensity toward impaired carbohydrate metabolism.
Collapse
|
37
|
Buchholz AC, Horrocks J, Martin Ginis KA, Bray SR, Craven BC, Hicks AL, Hayes KC, Latimer AE, McColl MA, Potter PJ, Smith K, Wolfe DL. Changes in traditional chronic disease risk factors over time and their relationship with leisure-time physical activity in people living with spinal cord injury. Appl Physiol Nutr Metab 2012; 37:1072-9. [DOI: 10.1139/h2012-085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This study examined whether levels of chronic disease risk factors change over time, and whether leisure-time physical activity (LTPA) can explain any of the variation in those risk factors that change, in a sample of community-dwelling people living with spinal cord injury (SCI) in or near Hamilton, Ontario, Canada. LTPA was measured using the Physical Activity Recall Assessment for People with SCI at baseline (n = 76 adults with chronic (≥1 year) paraplegia or tetraplegia), at 6 months (n = 71) and at 18 months (n = 63). Body mass index, waist circumference at the lowest rib (WClowest rib) and iliac crest (WCiliac crest), fat mass, blood pressure, and biochemical data were collected at all 3 time points. Women’s BMI was higher at baseline (least square means (LSM) = 26.2 ± SE = 1.56 kg·m–2, p = 0.0004) and 6 months (25.9 ± 1.6, p = 0.0024) than at 18 months (22.1 ± 1.72). Men’s WClowest ribincreased from baseline (92.1 ± 1.87 cm) to 18 months (93.6 ± 1.87, p = 0.0253). Women who were active vs. inactive at baseline had a lower BMI at 6 months (23.1 ± 2.91 vs. 29.7 ± 2.52, p = 0.0957) and WCiliac crestat 6 months (82.8 ± 6.59 vs. 97.7 ± 5.10, p = 0.0818). Women who were active vs. inactive at 6 months had a lower WCiliac crestat 18 months (73.4 ± 14.3 vs. 102.5 ± 6.41, p = 0.0723). There was little change in traditional risk factors over 18 months. Future studies should extend beyond 18 months in a larger sample, and explore traditional vs. novel risk factors and onset of cardiovascular disease and diabetes in the SCI population.
Collapse
Affiliation(s)
- Andrea C. Buchholz
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Julie Horrocks
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON N1G 2W1, Canada
| | | | - Steven R. Bray
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - B. Catharine Craven
- Department of Medicine, University of Toronto, and Toronto Rehabilitation Institute, Toronto, ON M6K 2R6, Canada
| | - Audrey L. Hicks
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Keith C. Hayes
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Amy E. Latimer
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Mary Ann McColl
- Centre for Health Services and Policy Research, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Patrick J. Potter
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Karen Smith
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Dalton L. Wolfe
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON N6A 3K7, Canada
| |
Collapse
|
38
|
Dionyssiotis Y. Malnutrition in spinal cord injury: more than nutritional deficiency. J Clin Med Res 2012; 4:227-36. [PMID: 22870169 PMCID: PMC3409617 DOI: 10.4021/jocmr924w] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 01/31/2023] Open
Abstract
Denervation of the spinal cord below the level of injury leads to complications producing malnutrition. Nutritional status affects mortality and pathology of injured subjects and it has been reported that two thirds of individuals enrolled in rehabilitation units are malnourished. Therefore, the aim should be either to maintain an optimal nutritional status, or supplement these subjects in order to overcome deficiencies in nutrients or prevent obesity. This paper reviews methods of nutritional assessment and describes the physiopathological mechanisms of malnutrition based on the assumption that spinal cord injured subjects need to receive adequate nutrition to promote optimal recovery, placing nutrition as a first line treatment and not an afterthought in the rehabilitation of spinal cord injury.
Collapse
Affiliation(s)
- Yannis Dionyssiotis
- Medical Department, Rehabilitation Center Amyntaio, General Hospital of Florina, 2nd km National Road Amyntaio-Thessaloniki, 53200, Amyntaio, Florina, Greece.
| |
Collapse
|
39
|
Alterations in mouse hypothalamic adipokine gene expression and leptin signaling following chronic spinal cord injury and with advanced age. PLoS One 2012; 7:e41073. [PMID: 22815920 PMCID: PMC3397960 DOI: 10.1371/journal.pone.0041073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 06/18/2012] [Indexed: 01/19/2023] Open
Abstract
Chronic spinal cord injury (SCI) results in an accelerated trajectory of several cardiovascular disease (CVD) risk factors and related aging characteristics, however the molecular mechanisms that are activated have not been explored. Adipokines and leptin signaling are known to play a critical role in neuro-endocrine regulation of energy metabolism, and are now implicated in central inflammatory processes associated with CVD. Here, we examine hypothalamic adipokine gene expression and leptin signaling in response to chronic spinal cord injury and with advanced age. We demonstrate significant changes in fasting-induced adipose factor (FIAF), resistin (Rstn), long-form leptin receptor (LepRb) and suppressor of cytokine-3 (SOCS3) gene expression following chronic SCI and with advanced age. LepRb and Jak2/stat3 signaling is significantly decreased and the leptin signaling inhibitor SOCS3 is significantly elevated with chronic SCI and advanced age. In addition, we investigate endoplasmic reticulum (ER) stress and activation of the uncoupled protein response (UPR) as a biological hallmark of leptin resistance. We observe the activation of the ER stress/UPR proteins IRE1, PERK, and eIF2alpha, demonstrating leptin resistance in chronic SCI and with advanced age. These findings provide evidence for adipokine-mediated inflammatory responses and leptin resistance as contributing to neuro-endocrine dysfunction and CVD risk following SCI and with advanced age. Understanding the underlying mechanisms contributing to SCI and age related CVD may provide insight that will help direct specific therapeutic interventions.
Collapse
|
40
|
Abstract
SETTING Spinal cord injury (SCI) causes devastating loss of function and can result in serious secondary complications. Although significant advances are being made to develop cellular and molecular therapies to promote regeneration, it is important to optimize physical interventions. OBJECTIVES The objective of this review was to examine the evidence for the effects of physical rehabilitation strategies on health and fitness, and maintenance of target systems below the level of injury (for example, muscle, bone, circulation). RESULTS Exercise appears to be a potent means of achieving these goals, using a variety of strategies. CONCLUSION Physical rehabilitation after SCI needs to move beyond the goal of maximizing independence to focus on maintenance of optimum health and fitness as well as maintenance of target system function below the level of injury. Issues requiring further investigation include identification of the optimum dosage of interventions to achieve specific goals, for example, prevention of muscle atrophy and osteoporosis, and development and validation of simple clinical measures to monitor the changes in body composition. Adoption of a classification system for physical interventions and standardized outcome measures would facilitate large-scale observational studies to identify the critical variables contributing to better outcomes.
Collapse
Affiliation(s)
- M P Galea
- Rehabilitation Sciences Research Centre, The University of Melbourne, Parkville, Victoria, Australia.
| |
Collapse
|
41
|
Eriks-Hoogland I, Hilfiker R, Baumberger M, Balk S, Stucki G, Perret C. Clinical assessment of obesity in persons with spinal cord injury: validity of waist circumference, body mass index, and anthropometric index. J Spinal Cord Med 2011; 34:416-22. [PMID: 21903016 PMCID: PMC3152814 DOI: 10.1179/2045772311y.0000000014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To study the relationship of waist circumference (WC) and bioelectrical impedance analysis (BIA) and degree of agreement between anthropometric index (AI) and BIA, using BIA as a reference or 'gold standard'. The second objective is to study the relationship between body mass index (BMI) and BIA in subjects with spinal cord injury (SCI). STUDY DESIGN Comparative cross-sectional study. SETTING Convenience sample at outpatient clinic of spinal cord center. OUTCOME MEASURES Estimation of obesity was made in 23 men with motor complete paraplegia (>1 year post-injury). Bland and Altman statistics were used to define level of agreement between AI and BIA, Pearson's r to describe correlation between WC and BIA and BMI and BIA. RESULTS Good agreement between BIA and AI with a small systematic difference in fat mass (FM) (mean difference: -0.28%, Pearson's r: 0.91) was found. The correlation between WC and the BIA (% FM) was very high (Pearson's r: 0.83). The correlation between WC and BMI (% FM) was just over moderate (Pearson's r: 0.51). CONCLUSION AI seems to be a valid proxy measure to estimate obesity in males living with SCI. Measurement of obesity in persons with SCI based on WC is promising. BMI showed not to be valid to estimate obesity in persons with SCI.
Collapse
Affiliation(s)
| | | | | | - Sarah Balk
- Swiss Paraplegic Research, Nottwil, Switzerland,Swiss Paraplegic Center, Nottwil, Switzerland
| | | | | |
Collapse
|
42
|
Emmons RR, Garber CE, Cirnigliaro CM, Kirshblum SC, Spungen AM, Bauman WA. Assessment of measures for abdominal adiposity in persons with spinal cord injury. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:734-741. [PMID: 21439716 DOI: 10.1016/j.ultrasmedbio.2011.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 01/25/2011] [Accepted: 02/03/2011] [Indexed: 05/30/2023]
Abstract
Ultrasound may be a useful tool to assess abdominal adiposity, but it has not been validated in the spinal cord injury (SCI) population. This study evaluated associations between abdominal ultrasound and other methods to assess adiposity in 24 men with SCI and 20 able-bodied (AB) men. Waist (WC) and hip circumference (HC) and waist-to-hip ratio (WHR) were measured. Trunk (TRK%), android (A%) and waist fat (W%) were determined by dual energy x-ray absorptiometry (DXA); ultrasonography determined abdominal subcutaneous (SF) and visceral fat (VF). The SCI group had greater TRK% (40.0 ± 9.6 vs. 32.0 ± 10.3), W% (47.0 ± 9.7 vs. 40.6 ± 9.4), A% (43.0 ± 9.8 vs. 35.8 ± 10.6) and WHR (0.99 ± 0.1 vs. 0.92 ± 0.06) than the AB group. WC and WHR correlated with VF in the SCI group. These associations suggest that ultrasound may be a useful tool in clinical practice for the measurement of VF in weight loss programs and for the assessment of cardiometabolic disorders.
Collapse
Affiliation(s)
- Racine R Emmons
- Department of Veterans Affairs, Rehabilitation Research and Development Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, USA.
| | | | | | | | | | | |
Collapse
|
43
|
An evidence-based review of aging of the body systems following spinal cord injury. Spinal Cord 2010; 49:684-701. [PMID: 21151191 DOI: 10.1038/sc.2010.178] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To systematically review evidence on aging of the body systems after spinal cord injury (SCI). SETTING Toronto, Ontario and Vancouver, British Columbia, Canada. METHODS Electronic databases (MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO), were searched for studies published between 1980 and 2009. The search was augmented by reviewing the reference lists of relevant papers. Non-intervention studies that were longitudinal or cross-sectional with able-bodied controls that were at minimum matched on chronological age were included for review. Levels of evidence were assigned to the study design using a modified Sackett scale. RESULTS Of the 74 studies selected for inclusion, 16 were longitudinal in design. The hypothesis that SCI represents a model for premature aging is supported by a large proportion of level 5 evidence for the cardiovascular and endocrine systems, level 2, 4 and 5 evidence for the musculoskeletal system, and limited level 5 evidence for the immune system. Only a few level 4 and 5 studies for the respiratory system were found. The evidence on the genitourinary system, gastrointestinal system, and for skin and subcutaneous tissues provide level 4 and 5 evidence that premature aging may not be occurring. The evidence on the nervous system does not provide evidence of premature aging as a result of SCI. CONCLUSIONS Premature aging appears to occur in some systems after SCI. Additional longitudinal studies are required to confirm these findings.
Collapse
|
44
|
Adkins R, Szlachcic Y, Govindarajan S. Metabolic Syndrome and Spinal Cord Injury: A 17-Year Longitudinal Study. Top Spinal Cord Inj Rehabil 2010. [DOI: 10.1310/sci1602-40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
45
|
van Duijnhoven NTL, Green DJ, Felsenberg D, Belavy DL, Hopman MTE, Thijssen DHJ. Impact of bed rest on conduit artery remodeling: effect of exercise countermeasures. Hypertension 2010; 56:240-6. [PMID: 20530294 DOI: 10.1161/hypertensionaha.110.152868] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physical inactivity is a potent stimulus for vascular remodeling, leading to a marked decrease in conduit artery diameter. However, little is known about the impact of physical inactivity on artery wall thickness or wall:lumen ratio or the potential of exercise countermeasures to modify artery wall thickness. The purpose of the study was to examine the impact of 60 days of bed rest, with or without exercise countermeasures, on carotid and superficial femoral artery wall thickness. Eighteen men were assigned to bed rest (second Berlin Bed Rest Study) and randomly allocated to control, resistive exercise, or resistive vibration exercise. Both exercise countermeasures were applied 3 times per week while the subjects were in the supine position on the bed. Sonography was used to examine baseline diameter and wall thickness of the carotid and femoral arteries. Bed rest decreased diameter of the superficial femoral artery (P=0.001) but not the carotid artery (P=0.29). Bed rest induced a significant increase in carotid and superficial femoral artery wall thickness (P=0.007 and 0.03) and wall:lumen ratio (P=0.009 and 0.001). Exercise prevented the increase in wall thickness of the carotid artery. In addition, exercise partly prevented the increased wall:lumen ratio in the superficial femoral artery. In conclusion, 8 weeks of bed rest resulted in approximately 20% increase in conduit artery wall thickness. Exercise countermeasures completely (carotid artery) or partly (superficial femoral artery) abolished the increase in wall thickness. These findings suggest that conduit artery wall thickness, a vascular characteristic associated previously with atherosclerosis, can rapidly adapt to physical inactivity and exercise in humans.
Collapse
|
46
|
|
47
|
Impact of exercise training on oxidative stress in individuals with a spinal cord injury. Eur J Appl Physiol 2010; 109:1059-66. [PMID: 20364349 PMCID: PMC2908461 DOI: 10.1007/s00421-010-1398-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2010] [Indexed: 10/30/2022]
Abstract
Individuals with a spinal cord injury (SCI) have an increased cardiovascular risk. We hypothesize that (anti)oxidative imbalance is associated with the increased cardiovascular risk in SCI, while exercise can reverse this status. The aim of the study is to compare baseline levels of oxidative stress and antioxidative capacity between individuals with SCI and able-bodied (AB) subjects, and to assess acute and long-term effects of functional electrical stimulation (FES) exercise on oxidative stress and antioxidative capacity in SCI. Venous blood was taken from subjects with an SCI (n = 9) and age- and gender-matched AB subjects (n = 9) to examine oxidative stress through malondialdehyde (MDA) levels, while superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzyme levels represented anti-oxidative capacity. Subsequently, subjects with an SCI performed an 8-week FES exercise training period. Blood was taken before and after the first exercise bout and after the last FES session to examine the acute and chronic effect of FES exercise, respectively. Baseline levels of MDA, SOD and GPx were not different between individuals with SCI and AB subjects. SCI demonstrated a correlation between initial fitness level and MDA (R = -0.83, P = 0.05). MDA, SOD and GPx levels were neither altered by a single FES exercise bout nor by 8 weeks FES training. In conclusion, although individuals with an SCI demonstrate a preserved (anti)oxidative status, the correlation between fitness level and (anti)oxidative balance suggests that higher fitness levels are related to improved (anti)oxidative status in SCI. Nonetheless, the FES exercise stimulus was insufficient to acutely or chronically change (anti)oxidative status in individuals with an SCI.
Collapse
|
48
|
Thijssen DHJ, Maiorana AJ, O’Driscoll G, Cable NT, Hopman MTE, Green DJ. Impact of inactivity and exercise on the vasculature in humans. Eur J Appl Physiol 2010; 108:845-75. [PMID: 19943061 PMCID: PMC2829129 DOI: 10.1007/s00421-009-1260-x] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2009] [Indexed: 12/12/2022]
Abstract
The effects of inactivity and exercise training on established and novel cardiovascular risk factors are relatively modest and do not account for the impact of inactivity and exercise on vascular risk. We examine evidence that inactivity and exercise have direct effects on both vasculature function and structure in humans. Physical deconditioning is associated with enhanced vasoconstrictor tone and has profound and rapid effects on arterial remodelling in both large and smaller arteries. Evidence for an effect of deconditioning on vasodilator function is less consistent. Studies of the impact of exercise training suggest that both functional and structural remodelling adaptations occur and that the magnitude and time-course of these changes depends upon training duration and intensity and the vessel beds involved. Inactivity and exercise have direct "vascular deconditioning and conditioning" effects which likely modify cardiovascular risk.
Collapse
Affiliation(s)
- Dick H. J. Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, 15–21 Webster Street, Liverpool, L3 2ET UK
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Andrew J. Maiorana
- Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Perth, Australia
- School of Physiotherapy, Curtin University of Technology, Perth, Australia
| | - Gerry O’Driscoll
- Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Perth, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Nigel T. Cable
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, 15–21 Webster Street, Liverpool, L3 2ET UK
| | - Maria T. E. Hopman
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Daniel J. Green
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, 15–21 Webster Street, Liverpool, L3 2ET UK
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Australia
| |
Collapse
|
49
|
Myers J. Cardiovascular Disease After SCI: Prevalence, Instigators, and Risk Clusters. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1403-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
50
|
Finnie AK, Buchholz AC, Martin Ginis KA. Current coronary heart disease risk assessment tools may underestimate risk in community-dwelling persons with chronic spinal cord injury. Spinal Cord 2008; 46:608-15. [DOI: 10.1038/sc.2008.21] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|