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Weijer VCR, Jonvik KL, van Dam L, Risvang L, Raastad T, van Loon LJC, Dijk JWV. Measured and Predicted Resting Metabolic Rate of Dutch and Norwegian Paralympic Athletes. J Acad Nutr Diet 2024:S2212-2672(24)00248-X. [PMID: 38763462 DOI: 10.1016/j.jand.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Although resting metabolic rate (RMR) is crucial for understanding athletes' energy requirements, limited information is available on the RMR of Paralympic athletes. OBJECTIVE The aim of this study was to determine RMR and its predictors in a diverse cohort of Paralympic athletes and evaluate the agreement between measured and predicted RMR from both newly developed and pre-existing equations. DESIGN This cross-sectional study, conducted between September 2020 and September 2022 in the Netherlands and Norway, assessed RMR in Paralympic athletes by means of ventilated hood indirect calorimetry and body composition by means of dual-energy x-ray absorptiometry. PARTICIPANTS Sixty-seven Paralympic athletes (male: n = 37; female: n = 30) competing in various sports, with a spinal cord disorder (n = 22), neurologic condition (n = 8), limb deficiency (n = 18), visual or hearing impairment (n = 7), or other disability (n = 12) participated. MAIN OUTCOME MEASURES RMR, fat-free mass (FFM), body mass, and triiodothyronine (T3) concentrations were assessed. STATISTICAL ANALYSES Multiple regression analyses were conducted with height, FFM, body mass, sex, T3 concentration, and disabilities as potential predictors of RMR. Differences between measured and predicted RMRs were analyzed for individual accuracy, root mean square error, and intraclass correlation. RESULTS Mean ± SD RMR was 1386 ± 258 kcal/d for females and 1686 ± 302 kcal/d for males. Regression analysis identified FFM, T3 concentrations, and the presence of a spinal cord disorder, as the main predictors of RMR (adjusted R2 = 0.71; F = 50.3; P < .001). The novel prediction equations based on these data, as well as pre-existing equations of Chun and colleagues and Nightingale and Gorgey performed well on accuracy (>60% of participants within 10% of measured RMR), had good reliability (intraclass correlation >0.78), and low root mean square error (≤141 kcal). CONCLUSIONS FFM, total T3 concentrations, and presence of spinal cord disorder are the main predictors of RMR in Paralympic athletes. Both the current study's prediction equations and those from Chun and colleagues and Nightingale and Gorgey align well with measured RMR, offering accurate prediction equations for the RMR of Paralympic athletes.
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Affiliation(s)
- Vera C R Weijer
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, the Netherlands; Department of Human Biology, NUTRIM, Maastricht University Medical Centre+, the Netherlands
| | - Kristin L Jonvik
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lotte van Dam
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Linn Risvang
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Luc J C van Loon
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, the Netherlands; Department of Human Biology, NUTRIM, Maastricht University Medical Centre+, the Netherlands
| | - Jan-Willem van Dijk
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, the Netherlands.
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Weijer VCR, Jonvik KL, VAN Dam L, Risvang L, Plasqui G, Sandbakk Ø, Raastad T, VAN Loon LJC, VAN Dijk JW. Energy Requirements of Paralympic Athletes: Insights from the Doubly Labeled Water Approach. Med Sci Sports Exerc 2024; 56:963-971. [PMID: 38194704 DOI: 10.1249/mss.0000000000003379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
PURPOSE Advanced insight in energy requirements of Paralympic athletes is imperative for optimizing their nutritional counseling. Given the lack of accurate data on total daily energy expenditure (TDEE) of Paralympic athletes, this study aimed to assess energy expenditure and nutritional intake of a large cohort of Paralympic athletes, across different sports and disabilities. METHODS In this cross-sectional study, 48 Dutch and Norwegian Paralympic athletes (19 male/29 female) with various disabilities, competing in Para cycling, wheelchair tennis, wheelchair basketball, Para Nordic skiing, and alpine skiing participated. TDEE was assessed by the gold standard doubly labeled water method over a 14-d period, resting metabolic rate by ventilated hood indirect calorimetry, energy intake by three unannounced 24-h dietary recalls, body composition by dual-energy x-ray absorptiometry, and exercise training duration by a training log. RESULTS Mean TDEE was 2908 ± 797 kcal·d -1 , ranging from 2322 ± 340 kcal·d -1 for wheelchair basketball players to 3607 ± 1001 kcal·d -1 for Para cyclists. Regression analysis identified fat-free mass, exercise duration, and the presence of a spinal cord disorder as the primary predictors of TDEE, explaining up to 73% of the variance in TDEE. Athletes' energy intake (2363 ± 905 kcal·d -1 ) was below their TDEE, whereas their body mass remained constant, indicating underreporting. Carbohydrate intake (4.1 ± 1.9 g·kg -1 body mass) was low, even when considering underreporting, whereas protein intake (1.8 ± 0.6 g·kg -1 body mass) was relatively high. CONCLUSIONS Paralympic athletes display moderate- to high-energy expenditure, varying across sports and individuals. Much of the variation in TDEE can be attributed to individual differences in fat-free mass and exercise duration. This study establishes the benchmarks for energy requirements of Paralympic athletes, serving as the foundation for future dietary guidelines within this population.
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Affiliation(s)
| | - Kristin L Jonvik
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, NORWAY
| | - Lotte VAN Dam
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | - Linn Risvang
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, NORWAY
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, NUTRIM, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - Øyvind Sandbakk
- Center for Elite Sports Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, NORWAY
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, NORWAY
| | | | - Jan-Willem VAN Dijk
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
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Alazzam AM, Alrubaye MW, Goldsmith JA, Gorgey AS. Trends in measuring BMR and RMR after spinal cord injury: a comprehensive review. Br J Nutr 2023; 130:1720-1731. [PMID: 37092679 PMCID: PMC10587382 DOI: 10.1017/s0007114523000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023]
Abstract
Studying factors that contribute to our understanding of maintaining normal energy balance are of paramount significance following spinal cord injury (SCI). Accurate determination of energy needs is crucial for providing nutritional guidance and managing the increasing prevalence of malnutrition or obesity after SCI. BMR represents 75-80 % of the total energy expenditure in persons with SCI. Accurately measuring BMR is an important component for calculating total energetic needs in this population. Indirect calorimetry is considered the gold-standard technique for measuring BMR. However, technical challenges may limit its applications in large cohort studies and alternatively rely on prediction equations. Previous work has shown that BMR changes in response to disuse and exercise in the range of 15-120 %. Factors including sex, level of injury and type of assistive devices may influence BMR after SCI. RMR is erroneously used interchangeably for BMR, which may result in overestimation of energetic intake when developing nutritional plans. To address this concern, we comprehensively reviewed studies that conducted BMR (n=15) and RMR (n=22) in persons with SCI. The results indicated that RMR is 9 % greater than BMR in persons with SCI. Furthermore, the SCI-specific prediction equations that incorporated measures of fat-free mass appeared to accurately predict BMR. Overall, the current findings highlighted the significance of measuring BMR as well as encouraging the research and clinical community to effectively establish countermeasures to combat obesity after SCI.
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Affiliation(s)
- Ahmad M. Alazzam
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Malak W. Alrubaye
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Jacob A. Goldsmith
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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Cross-Validation of a New General Population Resting Metabolic Rate Prediction Equation Based on Body Composition. Nutrients 2023; 15:nu15040805. [PMID: 36839163 PMCID: PMC9960966 DOI: 10.3390/nu15040805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Current prediction equations for resting metabolic rate (RMR) were validated in a relatively small sample with high-individual variance. This study determined the accuracy of five common RMR equations and proposed a novel prediction equation, including body composition. A total of 3001 participants (41 ± 13 years; BMI 28.5 ± 5.5 kg/m2; 48% males) from nutrition clinics in Israel were measured by indirect calorimetry to assess RMR. Dual-energy X-ray absorptiometry were used to evaluate fat mass (FM) and free-fat mass (FFM). Accuracy and mean bias were compared between the measured RMR and the prediction equations. A random training set (75%, n = 2251) and a validation set (25%, n = 750) were used to develop a new prediction model. All the prediction equations underestimated RMR. The Cunningham equation obtained the largest mean deviation [-16.6%; 95% level of agreement (LOA) 1.9, -35.1], followed by the Owen (-15.4%; 95% LOA 4.2, -22.6), Mifflin-St. Jeor (-12.6; 95% LOA 5.8, -26.5), Harris-Benedict (-8.2; 95% LOA 11.1, -27.7), and the WHO/FAO/UAU (-2.1; 95% LOA 22.3, -26.5) equations. Our new proposed model includes sex, age, FM, and FFM and successfully predicted 73.5% of the explained variation, with a bias of 0.7% (95% LOA -18.6, 19.7). This study demonstrates a large discrepancy between the common prediction equations and measured RMR and suggests a new accurate equation that includes both FM and FFM.
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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.
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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
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Jonvik KL, Vardardottir B, Broad E. How Do We Assess Energy Availability and RED-S Risk Factors in Para Athletes? Nutrients 2022; 14:1068. [PMID: 35268044 PMCID: PMC8912472 DOI: 10.3390/nu14051068] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 12/16/2022] Open
Abstract
Low energy availability (LEA) is considered to be the underlying cause of a number of maladaptations in athletes, including impaired physiological function, low bone mineral density (BMD), and hormonal dysfunction. This is collectively referred to as 'Relative Energy Deficiency in Sport' (RED-S). LEA is calculated through assessment of dietary energy intake (EI), exercise energy expenditure (EEE) and fat-free mass (FFM). The incidence of LEA in Paralympic athletes is relatively unknown; however, there are legitimate concerns that Para athletes may be at even higher risk of LEA than able-bodied athletes. Unfortunately, there are numerous issues with the application of LEA assessment tools and the criterion for diagnosis within the context of a Para population. The calculation of EEE, in particular, is limited by a distinct lack of published data that cover a range of impairments and activities. In addition, for several RED-S-related factors, it is difficult to distinguish whether they are truly related to LEA or a consequence of the athlete's impairment and medical history. This narrative review outlines deficits and complexities when assessing RED-S and LEA in Para athletes, presents the information that we do have, and provides suggestions for future progress in this important area of sports nutrition.
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Affiliation(s)
- Kristin L. Jonvik
- Department of Physical Performance, Norwegian School of Sport Sciences, 0806 Oslo, Norway
| | - Birna Vardardottir
- Faculty of Health Promotion, Sport and Leisure Studies, University of Iceland, 105 Reykjavik, Iceland;
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Nutritional Considerations for Para-Cycling Athletes: A Narrative Review. Sports (Basel) 2021; 9:sports9110154. [PMID: 34822353 PMCID: PMC8625771 DOI: 10.3390/sports9110154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 01/19/2023] Open
Abstract
Para-cycling is a sport including athletes with different disabilities competing on the track and on the roads using bicycles, tandems, tricycles, and handbikes. Scientific literature in this special population is scarce, especially in the field of sports nutrition. This review summarizes the physiological aspects and demands of para-cycling. This information together with the existing literature on nutritional interventions in this population, helps to discuss the nutritional considerations. To date, only a limited amount of recommendations are available for this population. In most para-cycling athletes, a reduction in active muscle mass and consequently a reduction in resting energy expenditure occurs, except for visually impaired athletes. Furthermore, carbohydrate and protein intake and hydration, supplementation, heat, and weight loss need to be tailored to the disability-specific adaptations such as the reduced active muscle mass, neurogenic bladder, and bowel, a reduced metabolic cost during exercise, and a higher risk of micronutrient deficiency.
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Changes in body composition during and after inpatient rehabilitation in people with recent spinal cord injury. Spinal Cord Ser Cases 2021; 7:88. [PMID: 34584070 DOI: 10.1038/s41394-021-00446-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To investigate changes in body composition parameters in people with recent spinal cord injury (SCI) during their first inpatient rehabilitation and up to 1 year after discharge and whether those potential changes over time varied between different personal and lesion characteristics groups. SETTING Rehabilitation center, the Netherlands. METHODS People with recent SCI (≥18 years; n = 53) were tested around admission (T0) and discharge (T1) of inpatient rehabilitation. A sub-group (n = 19) was measured 1 year after discharge (T2). Personal and lesion characteristics were registered at T0. Anthropometry (height, body mass, body mass index, and waist circumference) was performed at T0, T1, and T2. Bioelectrical impedance analysis (BIA) was measured at T0 and T1. RESULTS During inpatient rehabilitation, no significant changes in all body composition parameters were found. During the first year after discharge, body mass index (26.8 kg/m2) significantly increased compared with the level at both admission (25.4 kg/m2; p = 0.01, 95% CI: 0.32-2.52) and discharge (25.1 kg/m2; p = 0.02, 95% CI: 0.26-3.00). People with paraplegia showed an increase in absolute waist circumference (6.5%) compared with people with tetraplegia who showed a net decrease (-5.5%) in the year after discharge (p = 0.047, 95% CI: 0.27-33.62). CONCLUSIONS A stable body composition during inpatient rehabilitation is followed by an increased BMI in the year after discharge in people with recent SCI. People with paraplegia showed an increase in absolute waist circumference compared with people with tetraplegia who showed a net decrease in the year after discharge.
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Herrera-Amante CA, Ramos-García CO, Alacid F, Quiroga-Morales LA, Martínez-Rubio AJ, Bonilla DA. Development of alternatives to estimate resting metabolic rate from anthropometric variables in paralympic swimmers. J Sports Sci 2021; 39:2133-2143. [PMID: 34148529 DOI: 10.1080/02640414.2021.1922175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The resting metabolic rate (RMR) is one of the most representative components of total daily energy expenditure (TDEE). Multiple equations have been developed to estimate RMR, but none have been described for Para-Athletes. This study aimed to; i) develop and validate new RMR estimation models from anthropometric variables; and ii) explore the level of agreement between the RMR determined by indirect calorimetry (IC) and the developed models, as well as a selection of existent estimation models in Para-Athletes. Fifteen young Paralympic swimmers (age, 18.7±6.5 years) underwent assessments of RMR by IC and anthropometric batteries. Four RMR estimation models (M1-M4) were developed. The anthropometric variables which explained most of the variance were biacromial breadth (M3-37%), stature (M1-45%; M2-49%), and estimated stature from half arm span (M4-24%). However, the neck girth corrected by the submandibular skinfold entered in all four models. The 95% limits of agreement between IC and M3 equation (best performance model) ranged from -142.02 to 172.39 kcal×day-1 (bias 15.19 kcal×day-1). Concerning the commonly used equations, Harris & Benedict equation was the most consistent when compared to IC. The results of this study suggest four novel RMR equations that may assist in the estimation of energy requirements in elite Para-Athletes.
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Affiliation(s)
- Carlos Abraham Herrera-Amante
- Division of Health Sciences, Tonalá University Center, University of Guadalajara, Tonalá, México.,Research Division, Iberoamerican Institute of Sports Sciences and Human Movement, Guadalajara, México.,Ibero-American Network of Researchers in Applied Anthropometry, Almería, Spain
| | - César Octavio Ramos-García
- Division of Health Sciences, Tonalá University Center, University of Guadalajara, Tonalá, México.,Research Division, Iberoamerican Institute of Sports Sciences and Human Movement, Guadalajara, México.,Ibero-American Network of Researchers in Applied Anthropometry, Almería, Spain.,School of Public Health, Curtin University, Perth, Australia
| | - Fernando Alacid
- Ibero-American Network of Researchers in Applied Anthropometry, Almería, Spain.,Departament of Education, Health Research Centre, University of Almería, Spain fResearch Division, Dynamical Business & Science Society-DBSS International SAS, Bogotá, Colombia
| | - Luis Aaron Quiroga-Morales
- Research Division, Iberoamerican Institute of Sports Sciences and Human Movement, Guadalajara, México.,Ibero-American Network of Researchers in Applied Anthropometry, Almería, Spain
| | - Adrián Jacob Martínez-Rubio
- Research Division, Iberoamerican Institute of Sports Sciences and Human Movement, Guadalajara, México.,Ibero-American Network of Researchers in Applied Anthropometry, Almería, Spain
| | - Diego A Bonilla
- Ibero-American Network of Researchers in Applied Anthropometry, Almería, Spain.,Research Group in Biochemistry and Molecular Biology, Universidad Distrital Francisco José De Caldas, Bogotá, Colombia.,kDNA Genomics®, University of the Basque Country UPV/EHU, San Sebastián, Spain
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Cavedon V, Sandri M, Peluso I, Zancanaro C, Milanese C. Body composition and bone mineral density in athletes with a physical impairment. PeerJ 2021; 9:e11296. [PMID: 34026349 PMCID: PMC8117930 DOI: 10.7717/peerj.11296] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022] Open
Abstract
Background The impact of the type and the severity of disability on whole-body and regional body composition (BC), and bone mineral density (BMD) must be considered for dietary advice in athletes with a physical impairment (PI). This study aimed to investigate the impact of the type and the severity of disability on BC, the pattern of distribution of fat mass at the regional level, and BMD in athletes with a PI. Methods Forty-two male athletes with spinal cord injury (SCI, n = 24; age = 40.04 ± 9.95 years, Body Mass Index [BMI] = 23.07 ± 4.01 kg/m2) or unilateral lower limb amputation (AMP, n = 18; age = 34.39 ± 9.19 years, BMI = 22.81 ± 2.63 kg/m2) underwent a Dual-Energy X-Ray Absorptiometry scan. Each athlete with a PI was matched by age with an able-bodied athlete (AB, n = 42; age = 37.81 ± 10.31 years, BMI = 23.94 ± 1.8 kg/m2). Results One-Way Analysis of Variance showed significant differences between the SCI, AMP and AB groups for percentage fat mass (%FM) (P < 0.001, eta squared = 0.440). Post-hoc analysis with Bonferroni’s correction showed that athletes with SCI had significantly higher %FM vs. the AMP and AB groups (25.45 ± 5.99%, 21.45 ± 4.21% and 16.69 ± 2.56%, respectively; P = 0.008 vs. AMP and P < 0.001 vs. AB). The %FM was also significantly higher in the AMP vs. the AB group (P < 0.001). Whole-body BMD was negatively affected in SCI athletes, with about half of them showing osteopenia or osteoporosis. In fact, the mean BMD and T-score values in the SCI group (1.07 ± 0.09 g/cm2 and −1.25 ± 0.85, respectively) were significantly lower in comparison with the AB group (P = 0.001 for both) as well as the AMP group (P = 0.008 for both). The type of disability affected BC and BMD in the trunk, android, gynoid and leg regions in SCI athletes and the impaired leg only in AMP athletes. Conclusions In conclusion, the type of disability and, partly, the severity of PI impact on BC and BMD in athletes with a PI. Nutritionists, sports medicine doctors, clinicians, coaches and physical conditioners should consider athletes with SCI or AMP separately. Athletes with a PI would benefit from specific nutrition and training programs taking into account the type of their disability.
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Affiliation(s)
- Valentina Cavedon
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Sandri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ilaria Peluso
- Council for Agricultural Research and Economics (CREA-AN), Research Centre for Food and Nutrition, Rome, Italy
| | - Carlo Zancanaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Flueck JL, Parnell JA. Protein Considerations for Athletes With a Spinal Cord Injury. Front Nutr 2021; 8:652441. [PMID: 33928111 PMCID: PMC8076503 DOI: 10.3389/fnut.2021.652441] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Abstract
Athlete participation in the Paralympic games is steadily increasing; prompting research focused on the unique needs of this population. While the Paralympic Games includes a diversity of athletes, athletes with a spinal cord injury (PARA-SCI) represent a subgroup that requires specialized recommendations. Nutritional guidelines designed to optimize performance, in the context of the neurological impairments, are required. This narrative review summarizes the current literature regarding the importance of dietary protein for optimal health and performance. Factors with the potential to affect protein needs in PARA-SCI including loss of active muscle mass, reduced energy expenditure, and secondary complications are examined in detail. Furthermore, we analyze protein intakes in PARA-SCI from the available research to provide context around current practices and trends. In conclusion, we make the case that protein recommendations for able-bodied athletes may not be directly transferable to PARA-SCI. Consequently, PARA-SCI need their own guidelines to maximize performance and ensure long-term health.
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Affiliation(s)
| | - Jill A Parnell
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
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12
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Farkas GJ, Sneij A, Gater DR. Energy Expenditure Following Spinal Cord Injury: A Delicate Balance. Top Spinal Cord Inj Rehabil 2021; 27:92-99. [PMID: 33814887 PMCID: PMC7983637 DOI: 10.46292/sci20-00030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Following a spinal cord injury (SCI), neurogenic obesity results from changes in body composition, physical impairment, and endometabolic physiology and when dietary intake exceeds energy expenditure. Given the postinjury reductions in lean body mass, sympathetic nervous system dysfunction, and anabolic deficiencies, energy balance is no longer in balance, and thereby an obesogenic environment is created that instigates cardiometabolic dysfunction. Accurate determination of metabolic rate can prevent excess caloric intake while promoting positive body habitus and mitigating obesity-related comorbidities. Metabolic rate as determined by indirect calorimetry (IC) has not been adopted in routine clinical care for persons with SCI despite several studies indicating its importance. This article reviews current literature on measured and predicted metabolic rate and energy expenditure after SCI and stresses the importance of IC as standard of care for persons with SCI.
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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
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