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Pellegrini CA, Burkhart L, Ramey K, LaVela SL. Measuring Overweight and Obesity in Persons with Spinal Cord Injury: What Do Health Providers Use and What are the Challenges? Mil Med 2024; 189:e1661-e1667. [PMID: 38029316 DOI: 10.1093/milmed/usad468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/19/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Obesity is a significant health concern for veterans and individuals with spinal cord injury, yet screening for overweight/obesity can be challenging. This study examines how healthcare providers screen for overweight/obesity and the challenges encountered in identifying overweight/obesity in veterans and persons with spinal cord injury. MATERIALS AND METHODS Healthcare providers who provide care for persons with spinal cord injury completed a semi-structured interview. The interview explored their perspectives on measuring overweight/obesity in persons with spinal cord injury and the challenges they faced. Thematic analysis was used to identify themes that emerged from the interviews. RESULTS Twenty-five providers (88% female with an average experience of 9.6 ± 7.3 years in providing care for spinal cord injury patients) participated in the interviews. The themes described the health indicators and equipment used to assess overweight/obesity, provider concerns regarding measurement, and criteria for classifying overweight/obesity. Body weight and body mass index were the most commonly used indicators. However, concerns were raised regarding accuracy of these measures for spinal cord injury patients, as well as issues related to the accessibility, calibration, and usability of the equipment. Many providers reported using standard body mass index ranges and categories instead of those specific to spinal cord injury. CONCLUSION This study identified the most commonly used indicators of weight or body composition in veterans and persons with spinal cord injury and highlighted providers' concerns with these measures. Future research is needed to identify the most feasible, accurate, and appropriate health indicators that could be used in a clinical setting to identify overweight and obesity in this population.
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Affiliation(s)
- Christine A Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Lisa Burkhart
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Hines, IL 60141, USA
- Marcella Niehoff School of Nursing, Loyola University, Maywood, IL 60153, USA
| | - Kaitlyn Ramey
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Hines, IL 60141, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Blackburn AZ, Katakam A, Roberts T, Humphrey TJ, Salimy MS, Egan CR, Melnic CM, Bedair HS. Visceral Fat as a Risk Factor for Periprosthetic Joint Infection After Total Hip and Knee Arthroplasty. J Arthroplasty 2023; 38:1839-1845.e1. [PMID: 36858130 DOI: 10.1016/j.arth.2023.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Visceral obesity, a strong indicator of chronic inflammation and impaired metabolic health, has been shown to be associated with poor postoperative outcomes and complications. This study aimed to evaluate the relationship between visceral fat area (VFA) and periprosthetic joint infection (PJI) in total joint arthroplasty (TJA) patients. METHODS A retrospective study of 484 patients who had undergone a total hip or knee arthroplasty was performed. All patients had a computed tomography scan of the abdomen/pelvis within two years of their TJA. Body composition data (ie, VFA, subcutaneous fat area, and skeletal muscle area) were calculated at the Lumbar-3 vertebral level via two fully automated and externally validated machine learning algorithms. A multivariable logistic model was created to determine the relationship between VFA and PJI, while accounting for other PJI risk factors. Of the 484 patients, 31 (6.4%) had a PJI complication. RESULTS The rate of PJI among patients with VFA in the top quartile (> 264.1 cm2) versus bottom quartile (< 82.6 cm2) was 5.6% versus 10.6% and 18.8% versus 2.7% in the total hip arthroplasty and total knee arthroplasty cohorts, respectively. In the multivariate model, total knee arthroplasty patients with a VFA in the top quartile had a 30.5 times greater risk of PJI than those in the bottom quartile of VFA (P = .0154). CONCLUSION VFA may have a strong association with PJI in TJA patients. Using a standardized imaging modality like computed tomography scans to calculate VFA can be a valuable tool for surgeons when assessing risk of PJI.
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Affiliation(s)
- Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Thomas Roberts
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Tyler J Humphrey
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Cameron R Egan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
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Prevalence of Sarcopenic Obesity and Factors Influencing Body Composition in Persons with Spinal Cord Injury in Japan. Nutrients 2023; 15:nu15020473. [PMID: 36678344 PMCID: PMC9863685 DOI: 10.3390/nu15020473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
This study aims to investigate the prevalence of sarcopenic obesity and factors influencing body composition in persons with spinal cord injury (SCI) in Japan. Adults with SCI aged ≥ 20 years who underwent whole-body dual-energy X-ray absorptiometry between 2016 and 2022 were retrospectively analyzed. Data from 97 patients were examined. The primary outcome was appendicular skeletal muscle mass (ASM). Multiple linear regression analysis was conducted to assess factors influencing the lean and adipose indices in persons with SCI. Sarcopenia, obesity, and sarcopenic obesity were prevalent in 76%, 85%, and 64% of patients, respectively. Multivariate linear regression analysis revealed that sex (β = 0.34, p < 0.001), lesion level (β = 0.25, p = 0.007), severity (β = 0.20, p = 0.043), and ability to walk (β = 0.29, p = 0.006) were independently associated with ASM. Sex (β = −0.63, p < 0.001) was independently associated with percent body fat. In conclusion, sarcopenia, obesity, and sarcopenic obesity were prevalent among patients with SCI in Japan. Female sex, tetraplegia, motor-complete injury, and inability to walk were risk factors for sarcopenia, whereas female sex was a risk factor for obesity in persons with SCI. A routine monitoring of body composition is necessary, especially among those with multiple risk factors, to identify individuals in need of preventive and therapeutic interventions.
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Ichikawa H, Yasuda E, Kumada T, Takeshima K, Ogawa S, Tsunekawa A, Goto T, Nakaya K, Akita T, Tanaka J. Intra-individual comparison of liver stiffness measurements by magnetic resonance elastography and two-dimensional shear-wave elastography in 888 patients. Ultrasonography 2023; 42:65-77. [PMID: 36366945 PMCID: PMC9816707 DOI: 10.14366/usg.22052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Quantitative elastography methods, such as ultrasound two-dimensional shear-wave elastography (2D-SWE) and magnetic resonance elastography (MRE), are used to diagnose liver fibrosis. The present study compared liver stiffness determined by 2D-SWE and MRE within individuals and analyzed the degree of agreement between the two techniques. METHODS In total, 888 patients who underwent 2D-SWE and MRE were analyzed. Bland-Altman analysis was performed after both types of measurements were log-transformed to a normal distribution and converted to a common set of units using linear regression analysis for differing scales. The expected limit of agreement (LoA) was defined as the square root of the sum of the squares of 2D-SWE and MRE precision. The percentage difference was expressed as (2D-SWEMRE)/ mean of the two methods×100. RESULTS A Bland-Altman plot showed that the bias and upper and lower LoAs (ULoA and LLoA) were 0.0002 (95% confidence interval [CI], -0.0057 to 0.0061), 0.1747 (95% CI, 0.1646 to 0.1847), and -0.1743 (95% CI, -0.1843 to -0.1642), respectively. In terms of percentage difference, the mean, ULoA, and LLoA were -0.5944%, 19.8950%, and -21.0838%, respectively. The calculated expected LoA was 17.1178% (95% CI, 16.6353% to 17.6002%), and 789 of 888 patients (88.9%) had a percentage difference within the expected LoA. The intraclass correlation coefficient of the two methods indicated an almost perfect correlation (0.8231; 95% CI, 0.8006 to 0.8432; P<0.001). CONCLUSION Bland-Altman analysis demonstrated that 2D-SWE and MRE were interchangeable within a clinically acceptable range.
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Affiliation(s)
- Hideo Ichikawa
- Department of Medical Imaging, Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Eisuke Yasuda
- Department of Medical Imaging, Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Japan,Correspondence to: Eisuke Yasuda, PhD, Department of Medical Imaging, Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Mie 510- 0293, Japan Tel. +81-059-383-8991 Fax. +81-059-383-9666 E-mail:
| | - Takashi Kumada
- Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - Kenji Takeshima
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
| | - Sadanobu Ogawa
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akikazu Tsunekawa
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
| | - Tatsuya Goto
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koji Nakaya
- Department of Medical Imaging, Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
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Kumada T, Ogawa S, Goto T, Toyoda H, Yasuda S, Ito T, Yasuda E, Akita T, Tanaka J. Intra-individual Comparisons of the Ultrasound-Guided Attenuation Parameter and the Magnetic Resonance Imaging-Based Proton Density Fat Fraction Using Bias and Precision Statistics. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1537-1546. [PMID: 35613974 DOI: 10.1016/j.ultrasmedbio.2022.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Abstract
Ultrasound-based techniques using the attenuation coefficient, including the ultrasound-guided attenuation parameter (UGAP), have been developed for the quantification of hepatic steatosis. The magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) is considered to be more accurate than liver biopsy for liver fat quantification. The aim of this study was to perform intra-individual comparisons of UGAP and MRI-PDFF for determining hepatic steatosis grade. The study enrolled 309 patients who underwent UGAP and MRI-PDFF measurements. Bland-Altman analysis was conducted after transforming MRI-PDFF values to a normal distribution and converted to a common set of units using linear regression analysis for differing scales. The expected limits of agreement (LOA) was defined as the square root of the sum of the squares of UGAP and MRI-PDFF precision. A Bland-Altman plot revealed that the bias and upper and lower LOAs (ULOA and LLOA) were -0.0047, 0.1160 and -0.1255, respectively. The percentage difference indicated that the mean, ULOA and LLOA were -1.1434%, 18.1723% and -20.4590%, respectively. The calculated expected LOA was 18.5449%, and 283 of 309 patients (91.6%) had a percentage difference within 18.5449%. Bland-Altman analysis revealed that UGAP and MRI-PDFF were interchangeable within a clinically acceptable range.
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Affiliation(s)
- Takashi Kumada
- Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Gifu, Japan.
| | - Sadanobu Ogawa
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Tatsuya Goto
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Satoshi Yasuda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eisuke Yasuda
- Department of Radiological Technology, Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Mie, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
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Kuvijitsuwan B, Fongkaew K, Tengpanitchakul K, Dolkittanasophon J, Chunsanit S, Pattanakuhar S. Correlations between percent body fat measured by dual-energy X-ray absorptiometry and anthropometric measurements in Thai persons with chronic traumatic spinal cord injury. Spinal Cord 2022; 60:1094-1099. [PMID: 35773356 DOI: 10.1038/s41393-022-00828-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To determine and compare the correlations of percent body fat (%BF) evaluated by dual-energy X-ray absorptiometry (DEXA) and anthropometric measurements including body mass index (BMI), skinfold thickness, waist circumference, hip circumference, and waist to hip ratio in Thai persons with chronic traumatic spinal cord injury (SCI). SETTING An SCI-specialized rehabilitation facility in a university hospital. METHODS Forty-six Thais with chronic traumatic SCI from a chronic SCI cohort of Maharaj Nakorn Chiang Mai Hospital were enrolled. Anthropometric measurements including weight, height, BMI, waist circumference, hip circumference, waist to hip ratio, and skinfold thickness of four sites (biceps, triceps, subscapular, and suprailiac) were measured. The estimated %BF was calculated using the Durnin-Womersley formula based on the sum of 4-site skinfold thickness. Data of %BF was evaluated by DEXA within 3 months before anthropometric measurements of each participant were obtained. The correlations between each anthropometric parameter and % BF from DEXA were determined by the Pearson correlation coefficient. RESULTS The correlation of %BF between two methods, i.e., DEXA and estimation based on 4-site skinfold thickness, was strongly positive (r = 0.829; p < 0.001). The correlations between %BF from DEXA and hip circumference, BMI, and waist circumference were moderately positive (r = 0.697, 0.540, and 0.540, respectively; all p < 0.001). CONCLUSION Better than the other anthropometric measurements, the estimation of %BF based on the 4-site skinfold using the Durnin-Womersley formula is a practical method for evaluating obesity in Thai people with chronic traumatic SCI.
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Affiliation(s)
- Bhornsuree Kuvijitsuwan
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Korawit Fongkaew
- Medical student, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Supitcha Chunsanit
- Medical student, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sintip Pattanakuhar
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury. J Pers Med 2022; 12:jpm12071088. [PMID: 35887592 PMCID: PMC9320035 DOI: 10.3390/jpm12071088] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as “silent killers”, cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health.
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Goldsmith JA, Holman ME, Puri P, Khalil RE, Ennasr AN, Gorgey AS. The interaction of macronutrients and body composition among individuals with chronic spinal cord injury. Br J Nutr 2022; 129:1-12. [PMID: 35738897 PMCID: PMC9789189 DOI: 10.1017/s0007114522001830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Changes in body composition and dietary intake occur following spinal cord injury (SCI). The Geometric Framework for Nutrition (GFN) is a tool that allows the examination of the complex relationships between multiple nutrition factors and health parameters within a single model. This study aimed to utilize the GFN to examine the associations between self-reported macronutrient intakes and body composition in persons with chronic SCI. Forty-eight individuals with chronic SCI were recruited. Participants completed and returned 3- or 5-day self-reported dietary recall sheets. Dietary intake of macronutrients (fats, proteins, and carbohydrates) were analysed. Anthropometric measures (circumferences), dual-energy x-ray absorptiometry (DXA), and magnetic resonance imaging (MRI) were used to assess whlole-body composition. Associations between all circumference measures and carbohydrates were observed. Among MRI measures, only significant associations between subcutaneous adipose tissue and protein x carbohydrate as well as carbohydrates alone were identified. Carbohydrates were negatively associated with several measures of fat mass as measured by DXA. Overall, carbohydrates appear to play an important role in body composition among individuals with SCI. Higher carbohydrate intake was associated with lower fat mass. Additional research is needed to determine how carbohydrate intake influences body composition and cardiometabolic health after SCI.
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Affiliation(s)
- Jacob A. Goldsmith
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
| | - Matthew E. Holman
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Puneet Puri
- Internal Medicine Hepatology, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
| | - Refka E. Khalil
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
| | - Areej N. Ennasr
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA
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Shin JW, Kim T, Lee BS, Kim O. Factors Affecting Metabolic Syndrome in Individuals With Chronic Spinal Cord Injury. Ann Rehabil Med 2022; 46:24-32. [PMID: 35272437 PMCID: PMC8913272 DOI: 10.5535/arm.21144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/13/2021] [Indexed: 01/05/2023] Open
Abstract
Objective To assess the validity of different anthropometric measures (waist circumference [WC], body mass index [BMI], and percentage body fat) in diagnosing metabolic syndrome (MetS) among individuals with SCI and provides preliminary data for future studies in setting obesity cutoff values for this population. Methods This was a single-center retrospective cohort study. Sample information, anthropometric measures, and MetS variables of 157 individuals with chronic SCI were collected from an electronic medical records database. Results Increasing age (odds ratio [OR]=1.040, p=0.016) and lower neurological level of injury (OR=1.059, p=0.046) were risk factors for MetS. Male BMI (r=0.380, p<0.001) and male WC (r=0.346, p<0.001) were positively correlated with the number of MetS subfactors. Individuals with non-obese WC, excluding central obesity, were associated with having no MetS subfactors (p=0.005), and individuals with obese WC were associated with one or more subfactors (p=0.005). BMI was associated with MetS diagnosis (area under the curve=0.765, p<0.001), with the calculated cutoff value for BMI being 22.8 kg/m2. Conclusion This study calls for a stricter BMI cutoff for individuals with SCI in diagnosing MetS and warrants a large population-based study to define central obesity according to sex and ethnicity.
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Assessment of body composition in spinal cord injury: A scoping review. PLoS One 2021; 16:e0251142. [PMID: 33961647 PMCID: PMC8104368 DOI: 10.1371/journal.pone.0251142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/21/2021] [Indexed: 11/19/2022] Open
Abstract
The objective of this scoping review was to map the evidence on measurement properties of body composition tools to assess whole-body and regional fat and fat-free mass in adults with SCI, and to identify research gaps in order to set future research priorities. Electronic databases of PubMed, EMBASE and the Cochrane library were searched up to April 2020. Included studies employed assessments related to whole-body or regional fat and/or fat-free mass and provided data to quantify measurement properties that involved adults with SCI. All searches and data extractions were conducted by two independent reviewers. The scoping review was designed and conducted together with an expert panel (n = 8) that represented research, clinical, nutritional and lived SCI experience. The panel collaboratively determined the scope and design of the review and interpreted its findings. Additionally, the expert panel reached out to their professional networks to gain further stakeholder feedback via interactive practitioner surveys and workshops with people with SCI. The research gaps identified by the review, together with discussions among the expert panel including consideration of the survey and workshop feedback, informed the formulation of future research priorities. A total of 42 eligible articles were identified (1,011 males and 143 females). The only tool supported by studies showing both acceptable test-retest reliability and convergent validity was whole-body dual-energy x-ray absorptiometry (DXA). The survey/workshop participants considered the measurement burden of DXA acceptable as long as it was reliable, valid and would do no harm (e.g. radiation, skin damage). Practitioners considered cost and accessibility of DXA major barriers in applied settings. The survey/workshop participants expressed a preference towards simple tools if they could be confident in their reliability and validity. This review suggests that future research should prioritize reliability and validity studies on: (1) DXA as a surrogate 'gold standard' tool to assess whole-body composition, regional fat and fat-free mass; and (2) skinfold thickness and waist circumference as practical low-cost tools to assess regional fat mass in persons with SCI, and (3) females to explore potential sex differences of body composition assessment tools. Registration review protocol: CRD42018090187 (PROSPERO).
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Gorgey AS, Ennasr AN, Farkas GJ, Gater DR. Anthropometric Prediction of Visceral Adiposity in Persons With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:23-35. [PMID: 33814881 DOI: 10.46292/sci20-00055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over two-thirds of persons with spinal cord injury (SCI) experience neurogenic obesity-induced cardiometabolic syndrome (CMS) and other chronic comorbidities. Obesity is likely to impede social and recreational activities, impact quality of life, and impose additional socioeconomic burdens on persons with SCI. Advances in imaging technology facilitate the mapping of adiposity and its association with the cardiometabolic profile after SCI. Central adiposity or central obesity is characterized by increased waist (WC) and abdominal circumferences (AC) as well as visceral adipose tissue (VAT). A number of studies, while relying on expensive imaging techniques, have reported direct associations of both central obesity and VAT in imposing significant health risks after SCI. The mechanistic role of central obesity on cardiometabolic heath in persons with SCI has yet to be identified, despite the knowledge that it has been designated as an independent risk factor for cardiometabolic dysfunction and premature mortality in other clinical populations. In persons with SCI, the distribution of adipose tissue has been suggested to be a function of sex, level of injury, and age. To date, there is no SCI-specific WC or AC cutoff value to provide anthropometric prediction of VAT and diagnostic capability of persons at risk for central obesity, CMS, and cardiovascular disease after SCI. The purpose of the current review is to summarize the factors contributing to visceral adiposity in persons with SCI and to develop an SCI-specific anthropometric prediction equation for this population. Furthermore, a proposed WC cutoff will be discussed as a surrogate index for central obesity, CMS, and cardiovascular disorders after SCI.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, Richmond, Virginia.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Areej N Ennasr
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, Richmond, Virginia
| | - Gary J Farkas
- 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.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
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Gill S, Sumrell RM, Sima A, Cifu DX, Gorgey AS. Waist circumference cutoff identifying risks of obesity, metabolic syndrome, and cardiovascular disease in men with spinal cord injury. PLoS One 2020; 15:e0236752. [PMID: 32726371 PMCID: PMC7390405 DOI: 10.1371/journal.pone.0236752] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives To apply spinal cord injury (SCI) specific waist circumference (WC) cutoff point to identify risks of 1) obesity, 2) metabolic syndrome (MetS), 3) cardiovascular disease (CVD). Methods Thirty-six men with chronic SCI underwent anthropometric measurements, dual-energy x-ray absorptiometry (DXA), and magnetic resonance imaging (MRI) to measure total and regional adiposity. An SCI specific WC cutoff point of 86.5 cm was applied to the existing general population criteria. Pearson chi-square (χ2) analyses tested the difference in the number of participants classified as obese using the SCI specific cutoff point compared to the general population criteria. Sensitivity and specificity analyses relative to percentage body fat mass and visceral adipose tissue was used to assess classification performance of this cutoff point. The interrater reliability for three definitions of MetS was assessed using Cohen’s Kappa (κ) values. Linear regression analyses were utilized to propose SCI specific Framingham Coronary Heart Disease Risk Score (FRS) cutoff value. Results Using SCI specific WC cutoff point of 86.5 cm, 36% of participants were classified as obese compared to only 3% when using WC of 102 cm (P < 0.001). Relative to percentage body fat mass, the general population WC cutoff point of 102 cm had a sensitivity of 6.3% and specificity of 100% both which changed to 68.8% and 90%, respectively, with a SCI specific cutoff point of 86.5 cm. Similar results were obtained when using visceral adipose tissue as a reference. The Kappa (κ) values improved substantially after using SCI specific criteria (0.95 ± 0.05) compared to the general population criteria (0.47 ± 0.28) for three definitions of MetS. The SCI specific FRS cutoff value of 6 was predicted after applying a WC cutoff of 86.5 cm. Conclusions Using the existing general population criteria underestimated persons with SCI who are at risk of developing obesity, MetS, and CVD. The recommended SCI specific criteria are likely to distinguish those at risks of developing comorbidities and allow healthcare providers to intervene in a timely manner.
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Affiliation(s)
- Satinder Gill
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States of America
| | - Ryan M. Sumrell
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States of America
| | - Adam Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States of America
| | - David X. Cifu
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States of America
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States of America
- * E-mail:
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McCauley LS, Ghatas MP, Sumrell RM, Cirnigliaro CM, Kirshblum SC, Bauman WA, Gorgey AS. Measurement of Visceral Adipose Tissue in Persons With Spinal Cord Injury by Magnetic Resonance Imaging and Dual X-Ray Absorptiometry: Generation and Application of a Predictive Equation. J Clin Densitom 2020; 23:63-72. [PMID: 30638769 DOI: 10.1016/j.jocd.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Dual energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI) permits quantification of visceral adipose tissue (VAT). However, DXA has not been validated against MRI in persons with chronic spinal cord injury (SCI). A predictive equation was generated from the measurement of VAT by MRI, a "gold" standard to quantitate VAT, compared to that of DXA, a method with several practical advantages. METHOD DXA and MRI scans were performed in 27 participants with SCI. MRI multiaxial images were captured for VAT analysis. DXA-VAT was quantified at the android region (DXA-VATANDROID-VOL) using enCore software. Android regions of DXA and MRI were matched using android height. Volumes of multiaxial MRI-VAT and subcutaneous adipose tissue (SAT) were quantified for the android region (MRI-VATANDROID-VOL, MRI-SATANDROID-VOL) and total trunk (MRI-VATANDROID-VOL). Linear regression analysis was used to establish the proposed predication equations. The prediction equations were then applied to an independent sample that consisted of 98 participants with SCI. Bland-Altman analysis was used to determine the limits of agreement. RESULTS DXA-VATANDROID-VOL predicted 92% of the variance in MRI-VATANDROID-VOL (SEE = 252.5, p < 0.0005) and 85% of the variance in MRI-VATTRUNK-VOL (SEE = 1526.9, p < 0.0005). DXA-SATANDROID-VOL predicted 81.5% of the variance in MRI-SATANDROID-VOL (SEE = 458.2, p < 0.0005). Bland-Altman analysis revealed a high level of agreement between MRI-VATANDROID-VOL and DXA-VATANDROID-VOL (mean bias = 58.45 cm3). A predicted mean DXA-VATANDROID-VOL of 995.2 cm3 was estimated as the population-specific cut-off point for high levels of VAT. CONCLUSION DXA-VATANDROID-VOL may accurately predict MRI-VATANDROID-VOL in persons with SCI. The ability of DXA to detect VAT changes in longitudinal studies in persons with SCI should be performed.
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Affiliation(s)
- Liron S McCauley
- Spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Mina P Ghatas
- Spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Ryan M Sumrell
- Spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical Center, Richmond, VA, 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, NY, USA
| | - Steven C Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, 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, NY, USA; Departments of Medicine and Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA; Physical Medicine and Rehabilitation Virginia Commonwealth University, Richmond, VA, USA.
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14
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Sumrell RM, Nightingale TE, McCauley LS, Gorgey AS. Anthropometric cutoffs and associations with visceral adiposity and metabolic biomarkers after spinal cord injury. PLoS One 2018; 13:e0203049. [PMID: 30169541 PMCID: PMC6118379 DOI: 10.1371/journal.pone.0203049] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 08/10/2018] [Indexed: 01/21/2023] Open
Abstract
Background/Objectives To examine associations of different anthropometric measurements of central adiposity to visceral adipose tissue (measured via multi-axial magnetic resonance imaging; MRI) and cardiometabolic disease risk factors in men with spinal cord injury (SCI). Additionally, to determine population-specific seated/supine waist and abdominal circumference cutoffs, which may identify men at increased risk of cardiometabolic disease. Participants/Methods Twenty-two men with chronic SCI underwent MRI scans, anthropometric measurements along with assessments of various cardiometabolic risk biomarkers. Pearson/part (accounting for age as a covariate) correlation coefficients were calculated to determine the associations between study variables. Abdominal and waist circumference cutoffs were extrapolated using the slope of linear regression equations. Results Seated/supine abdominal and waist circumferences were (P < 0.01) associated with MRI visceral fat cross-sectional area (VATCSA), VAT volume and CSA:TotalCSA. Low density lipoprotein, non-high-density lipoprotein and total cholesterol were positively associated with seated/supine abdominal and waist circumferences after controlling for age; r = 0.50–0.61, r = 0.46–0.58, r = 0.52–0.58, P < 0.05, respectively. Tumor necrosis factor alpha was associated with seated/supine abdominal and waist circumferences after accounting for age; r = 0.49–0.51 and r = 0.48–0.56, P < 0.05 respectively. The population-specific cutoffs were 86.5cm and 88.3cm for supine waist and abdominal circumferences, respectively, as well as 89cm and 101cm for seated waist and abdominal circumferences, respectively. After dichotomizing VATCSA (< or ≥ 100cm2), peak oxygen uptake, triglycerides, insulin sensitivity and glycated hemoglobin were different (P < 0.05) between groups. After dichotomizing (< or ≥ 86.5cm) supine waist circumference, VATCSA, triglycerides and insulin sensitivity were different (P < 0.05) between groups. Conclusions Seated/supine circumferences are associated with both central adiposity and biomarkers of cardiometabolic disease risk in persons with SCI. Population-specific cutoffs are proposed herein to identify central adiposity and potential cardiometabolic disease risk after SCI.
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Affiliation(s)
- Ryan M Sumrell
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States of America
| | - Thomas E Nightingale
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States of America
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Liron S McCauley
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States of America
| | - Ashraf S Gorgey
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States of America
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States of America
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Yun JH, Chun SM, Kim JC, Shin HI. Obesity cutoff values in Korean men with motor complete spinal cord injury: body mass index and waist circumference. Spinal Cord 2018; 57:110-116. [PMID: 29976960 DOI: 10.1038/s41393-018-0172-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/23/2018] [Accepted: 06/12/2018] [Indexed: 12/19/2022]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To determine the obesity cutoff values for body mass index (BMI) and waist circumference (WC) in Korean men with motor complete spinal cord injury (SCI). SETTING Tertiary level hospital in Seoul, Korea. METHODS BMI (kg/m2) was calculated and WC (cm) was measured in each participant in the supine position. Percentage of total body fat (%) was determined using whole-body dual-energy X-ray absorptiometry. Receiver operating characteristic curves were generated to determine the obesity cutoff values for BMI and WC. The optimal cutoff values were determined using the Youden index. Identified cutoff values were compared with those of 195 age- and BMI-matched men in the general population (GP), obtained from the Korea National Health and Nutrition Examination Survey. RESULTS This study included 52 Korean men with motor complete SCI. A BMI of 20.2 kg/m2 and WC of 81.3 cm were identified as obesity cutoff values in Korean men with motor complete SCI. The area under the curve (AUC) was 0.928, specificity was 100%, and sensitivity was 84.8% according to the ROC curve of BMI for participants. AUC was 0.964, specificity was 100%, and sensitivity was 84.8% in the ROC curve of WC for participants. A BMI of 22.5 kg/m2 and WC of 85.5 cm were identified as obesity cutoff values in age- and BMI-matched men in the GP. CONCLUSIONS The obesity cutoff values in Korean men with motor complete SCI that were determined in this study were lower than those of the Korean GP and western people with SCI.
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Affiliation(s)
- Jae-Hyun Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Min Chun
- Department of Rehabilitation Medicine, Purme Children's Rehabilitation Hospital, Seoul, Korea
| | - Ju-Chan Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.
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McCauley LS, Sumrell RM, Gorgey AS. Anthropometric Prediction of Visceral Adipose Tissue in Persons With Motor Complete Spinal Cord Injury. PM R 2018; 10:817-825.e2. [PMID: 29474998 DOI: 10.1016/j.pmrj.2018.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/05/2018] [Accepted: 02/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) results in increased accumulation of visceral adipose tissue (VAT). Anthropometrics may provide an alternative to estimate VAT cross-section area (CSA) compared to magnetic resonance imaging (MRI). OBJECTIVE To validate the use of anthropometrics, including abdominal circumference and skinfold thickness (SFT) measurements against MRI to predict subcutaneous adipose tissue (SAT) and VAT cross-sectional areas in persons with SCI. DESIGN Cross-sectional. SETTING Clinical research center PARTICIPANT: Twenty-two men with motor complete SCI METHODS: Anthropometric measurements and MRI were taken during a single visit. Abdominal circumference and SFT were used to derive prediction equations for subcutaneous adipose tissue (SATAnthro-CSA) and VAT (VATAnthro-CSA). Three-axial MRI at the level of umbilicus was used to establish the prediction equations. VATAnthro-CSA was compared against body mass index (BMI), waist circumference, and SFT. Bland-Altman plots were used to determine limits of agreement between prediction equations and MRI. MAIN OUTCOME MEASUREMENTS SAT and VAT cross-sectional areas. RESULTS SATAnthro-CSA explained 76% of the variance in SAT cross-sectional area (r2 = 0.76, standard error of the estimate [SEE] = 49.5 cm2, P <.001). VATAnthro-CSA explained 72% of VAT cross-sectional area (r2 = 0.72, SEE = 45.8 cm2, P <.001). Compared to VATAnthro-CSA, BMI, waist circumference, and SFT explained only 37%, 63%, and 31%, respectively, in the variance of VAT MRI. CONCLUSION Abdominal circumference and SFT demonstrated an alternative way to predict VAT CSA. VATAnthro-CSA estimated VATMRI more accurately than BMI, waist circumference, and SFT in individuals with chronic SCI. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Liron S McCauley
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA.,Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA; Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA 23249
| | - Ryan M Sumrell
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA.,Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA; Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA 23249
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA.,Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA; Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA 23249
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Lieberman JA, McClelland JW, Goff DC, Racine E, Dulin MF, Bauman WA, Niemeier J, Hirsch MA, Norton HJ, Moore CG. Nutrition education for cardiovascular disease prevention in individuals with spinal cord injuries: study protocol for a randomized controlled trial. Trials 2017; 18:584. [PMID: 29202852 PMCID: PMC5716386 DOI: 10.1186/s13063-017-2263-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022] Open
Abstract
Background Individuals with chronic spinal cord injuries (SCIs) have an increased prevalence of cardiovascular disease (CVD) and associated risk factors compared with age-matched control subjects. Exercise has been shown to improve selected CVD risk factors in individuals with SCI, but using nutrition education as an intervention has not been evaluated in this population. This paper describes our research plan for evaluating the effect of nutrition education on individuals with SCI. In the present study, called Eat Smart, Live Better, we are using a randomized controlled design to test an intervention adapted from an existing evidence-based program that showed a positive effect on nutrition knowledge and behavior of older adults from the general population. There will be an inpatient group (n = 100) and a community group (n = 100). The aims of our study are to compare the intervention and control groups for (1) changes in nutritional behavior, nutritional knowledge, and dietary quality by participants in the program; (2) levels of adiposity and metabolic CVD risk factors at 12-month follow-up; and (3) differential effects among individuals with SCI in the acute rehabilitation setting and those living in the community. Methods/design This is a randomized controlled trial of nutrition education. The treatment groups receive six nutrition education sessions. The control groups receive the one “standard of care” nutrition lecture that is required by the Commission on Accreditation of Rehabilitation Facilities. Treatment groups include both an inpatient group, comprising patients who have been admitted to an acute rehabilitation facility because of their recent SCI, and an outpatient group, consisting of community-dwelling adults who are at least 1 year after their SCI. A total of 200 participants will be randomized 1:1 to the intervention or control group, stratified by location (acute rehabilitation facility or community dwelling). Discussion To our knowledge, this will be the first reported study of nutrition education in individuals with SCI. The low cost and feasibility of the intervention, if shown to improve nutritional behavior, suggests that it could be implemented in rehabilitation facilities across the country. This has the potential of lowering the burden of CVD and CVD risk factors in this high-risk population. Trial registration ClinicalTrials.gov, NCT02368405. Registered on February 10, 2015.
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Affiliation(s)
- Jesse A Lieberman
- Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA.
| | | | - David C Goff
- National, Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Suite 8030, Bethesda, MD, 20892, USA
| | - Elizabeth Racine
- University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA
| | - Michael F Dulin
- University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA
| | - William A Bauman
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
| | - Janet Niemeier
- Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Mark A Hirsch
- Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - H James Norton
- Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Charity G Moore
- Center for Outcomes Research and Evaluation, Carolinas HealthCare System, 1540 Garden Terrace Road, Charlotte, NC, 28203, USA
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Abstract
CONTEXT Individuals with chronic spinal cord injury (SCI) are susceptible to central and visceral obesity and it's metabolic consequences; consensus based guidelines for obesity management after SCI have not yet been stablished. OBJECTIVES To identify and compare effective means of obesity management among SCI individuals. METHODS This systematic review included English and non-English articles, published prior to April 2017 found in the PubMed/Medline, Embase, CINAHL Psychinfo and Cochrane databases. Studies evaluating any obesity management strategy, alone or in combination, including: diet therapy, voluntary and involuntary exercise such as neuro-muscular electric stimulation (NMES), pharmacotherapy, and surgery, among individuals with chronic SCI were included. Outcomes of interest were reductions in waist circumference, body weight (BW), body mass index (BMI) and total fat mass (TFM) and increases in total lean body mass (TLBM) from baseline. From 3,553 retrieved titles and abstracts, 34 articles underwent full text review and 23 articles were selected for data abstraction. Articles describing weight loss due to inflammation, cancer or B12 deficiency were excluded. The Downs and Black reported poor to moderate quality of the studies. RESULTS Bariatric surgery produced the greatest permanent weight reduction and BMI correction followed by combinations of physical exercise and diet therapy. Generally, NMES and pharmacotherapy improved TLBM and reduced TFM but not weight. CONCLUSIONS The greatest weight reduction and BMI correction was produced by bariatric surgery, followed by a combination of physical exercise and diet therapy. NMES and pharmacologic treatment did not reduce weight or TFM but increased in TLBM.
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Affiliation(s)
- Mir Hatef Shojaei
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation, Toronto, ON, Canada
| | - Seyed Mohammad Alavinia
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation, Toronto, ON, Canada
| | - B. Catharine Craven
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation, Toronto, ON, Canada
- Department of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
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Gorgey AS, Farkas GJ, Dolbow DR, Khalil RE, Gater DR. Gender Dimorphism in Central Adiposity May Explain Metabolic Dysfunction After Spinal Cord Injury. PM R 2017; 10:338-348. [PMID: 28827208 DOI: 10.1016/j.pmrj.2017.08.436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/20/2017] [Accepted: 08/03/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Increase in visceral adipose tissue (VAT) is an independent risk for mortality and other health-related comorbidities. OBJECTIVE To examine the gender differences in VAT and subcutaneous adipose tissue (SAT) cross-sectional areas (CSA) between men and women with chronic spinal cord injury (SCI). The differences in the distribution of central adiposity were used to determine the association of VAT and SAT to metabolic dysfunction after SCI. DESIGN Cross-sectional design. SETTING Hospital-based study. PARTICIPANTS Sixteen individuals (8 men and 8 women) with motor complete SCI were matched based on age, time since injury, and level of injury. METHODS Anthropometrics, dual x-ray absorptiometry (DXA), and magnetic resonance imaging were captured to measure lean mass, fat mass (FM), percentage FM, VAT, and SAT CSAs. Basal metabolic rate was measured, and intravenous glucose tolerance test and lipid panel were performed. MAIN OUTCOME MEASUREMENTS VAT, SAT, and metabolic profile. RESULTS SAT CSA was 1.6 -1.75 times greater in the upper and lower trunks in women compared to men with SCI (P < .05). VAT CSA was 1.8-2.6 times greater in the upper and lower trunks in men compared to women with SCI (P < .05). VAT adjusted to body weight was greater in men compared to women with SCI. High-density lipoprotein cholesterol (HDL-C) was positively related to SAT and negatively related to VAT. Glucose effectiveness was negatively related to lower trunk SAT (r = -0.60, P = .02). HDL-C ratio and triglycerides were positively related to upper VAT, lower VAT, and VAT:SAT ratio. CONCLUSION Magnetic resonance imaging demonstrated that there is a gender dimorphism in central adiposity in persons with chronic SCI. This gender dimorphism in central adipose tissue distribution may explain the higher prevalence of metabolic dysfunction in men with SCI, especially, the decrease in the HDL-C profile. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, 1201 Broad Rock Blvd, Richmond, VA 23249; Virginia Commonwealth University, Department of Physical Medicine & Rehabilitation, Richmond, VA.,Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA.,School of Kinesiology, University of Southern Mississippi, Hattiesburg, MI.,Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, Richmond, VA.,Department of Physical Medicine and Rehabilitation and Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Gary J Farkas
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, 1201 Broad Rock Blvd, Richmond, VA 23249; Virginia Commonwealth University, Department of Physical Medicine & Rehabilitation, Richmond, VA.,Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA.,School of Kinesiology, University of Southern Mississippi, Hattiesburg, MI.,Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, Richmond, VA.,Department of Physical Medicine and Rehabilitation and Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - David R Dolbow
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, 1201 Broad Rock Blvd, Richmond, VA 23249; Virginia Commonwealth University, Department of Physical Medicine & Rehabilitation, Richmond, VA.,Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA.,School of Kinesiology, University of Southern Mississippi, Hattiesburg, MI.,Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, Richmond, VA.,Department of Physical Medicine and Rehabilitation and Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Refka E Khalil
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, 1201 Broad Rock Blvd, Richmond, VA 23249; Virginia Commonwealth University, Department of Physical Medicine & Rehabilitation, Richmond, VA.,Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA.,School of Kinesiology, University of Southern Mississippi, Hattiesburg, MI.,Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, Richmond, VA.,Department of Physical Medicine and Rehabilitation and Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - David R Gater
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, 1201 Broad Rock Blvd, Richmond, VA 23249; Virginia Commonwealth University, Department of Physical Medicine & Rehabilitation, Richmond, VA.,Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA.,School of Kinesiology, University of Southern Mississippi, Hattiesburg, MI.,Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, Richmond, VA.,Department of Physical Medicine and Rehabilitation and Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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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.
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Pelletier CA, Miyatani M, Giangregorio L, Craven BC. Sarcopenic Obesity in Adults With Spinal Cord Injury: A Cross-Sectional Study. Arch Phys Med Rehabil 2016; 97:1931-1937. [PMID: 27282328 DOI: 10.1016/j.apmr.2016.04.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe (1) the frequency and utility of clinically relevant spinal cord injury (SCI)-specific and general population thresholds for obesity and sarcopenic obesity; and (2) the fat and lean soft tissue distributions based on the neurologic level of injury and the American Spinal Injury Association Impairment Scale. DESIGN Cross-sectional. SETTING Tertiary SCI rehabilitation hospital. PARTICIPANTS Persons (N=136; men, n=100; women, n=36) with chronic (mean ± SD: 15.6±11.3y postinjury) tetraplegia (n=66) or paraplegia (n=70). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Body composition was assessed with anthropometrics and whole-body dual-energy x-ray absorptiometry. Muscle atrophy was quantified using a sarcopenia threshold of appendicular lean mass index (ALMI) (men, ≤7.26kg/m2; women, ≤5.5kg/m2). Obesity was defined by percentage body fat (men, ≥25%; women, ≥35%), visceral adipose tissue (≥130cm2), and SCI-specific obesity thresholds (body mass index [BMI] ≥22kg/m2; waist circumference ≥94cm). Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Groups were compared based on impairment characteristics using an analysis of covariance. RESULTS Sarcopenic obesity was prevalent in 41.9% of the sample. ALMI was lower among participants with motor-complete (6.2±1.3kg/m2) versus motor-incomplete (7.5±1.6kg/m2) injuries (P<.01). Whole-body fat was greater among participants with tetraplegia (28.8±11.2kg) versus paraplegia (24.1±8.7kg; P<.05). Compared with general population guidelines (20.6%), SCI-specific BMI thresholds identified all the participants with obesity (77.9%) based on percentage body fat (72.1%). CONCLUSIONS The observed frequency of sarcopenic obesity in this sample of individuals with chronic SCI is very high, and identification of obesity is dissimilar when using SCI-specific versus general population criteria.
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Affiliation(s)
- Chelsea A Pelletier
- Toronto Rehabilitation Institute-University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, Ontario, Canada.
| | - Masae Miyatani
- Toronto Rehabilitation Institute-University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, Ontario, Canada
| | - Lora Giangregorio
- Toronto Rehabilitation Institute-University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, Ontario, Canada; Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - B Catharine Craven
- Toronto Rehabilitation Institute-University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Sato E, Mori T, Satoh M, Fujiwara M, Nakamichi Y, Oba I, Ogawa S, Kinouchi Y, Sato H, Ito S, Hida W. Urinary angiotensinogen excretion is associated with blood pressure in obese young adults. Clin Exp Hypertens 2016; 38:203-8. [DOI: 10.3109/10641963.2015.1081219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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