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de Groot S, Adriaansen JJE, Stolwijk-Swüste JM, Osterthun R, van den Berg-Emons RJG, Post MWM. Obesity in wheelchair users with long-standing spinal cord injury: prevalence and associations with time since injury and physical activity. Spinal Cord 2024; 62:378-386. [PMID: 38649757 DOI: 10.1038/s41393-024-00995-6] [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: 11/14/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
STUDY DESIGN Secondary analysis of cross-sectional data from the ALLRISC cohort study. OBJECTIVES To investigate the prevalence of obesity and its association with time since injury (TSI) and physical activity (PA) in wheelchair users with long-standing (TSI > 10 years) spinal cord injury (SCI). SETTING Community, The Netherlands. METHODS Wheelchair users with SCI (N = 282) in TSI strata (10-19, 20-29, and ≥30 years) and divided in meeting SCI-specific exercise guidelines or not. Waist circumference (WC) and body mass index (BMI) were assessed. Participants were classified as being obese (WC > 102 cm for men, WC > 88 cm for women; BMI ≥ 25 kg/m2) or not. Logistic regression analyses were performed to investigate the associations between obesity and TSI and PA. RESULTS Almost half of the participants (45-47%) were classified as obese. TSI was significantly associated with obesity, the odds of being obese were 1.4 higher when having a 10 years longer TSI. Furthermore, the odds of being obese were 2.0 lower for participants who were meeting the exercise guidelines. CONCLUSIONS The prevalence of obesity is high in people with long-standing SCI. Those with a longer TSI and individuals who do not meet the exercise guidelines are more likely to be obese and need to be targeted for weight management interventions.
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Affiliation(s)
- Sonja de Groot
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands.
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | | | - Janneke M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Rutger Osterthun
- Rijndam Rehabilitation, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marcel W M Post
- De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Centre for Rehabilitation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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Mercier HW, Solinsky R, Taylor JA. Relationship of cardiometabolic disease risk factors with age and spinal cord injury duration. J Spinal Cord Med 2024; 47:379-386. [PMID: 35485952 PMCID: PMC11044727 DOI: 10.1080/10790268.2022.2065410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT/OBJECTIVES Cardiometabolic disease (CMD) is increased after spinal cord injury (SCI), with an increased number of CMD risk factors that relate to higher mortality. The study objective was to characterize the relationship of age and injury duration with CMD. DESIGN Retrospective cohort assessment of CMD risks using unbiased recursive partitioning to divide for group comparison: (1) Lowest Risk, (2) Moderate Risk, and (3) Highest Risk based on classification and regression trees predicting CMD diagnosis by age and injury duration. SETTING Academic rehabilitation center laboratory. PARTICIPANTS Adults (N = 103; aged 18-75) with traumatic SCI (C4-L2) of 3 months to 42 years duration. INTERVENTIONS NA. OUTCOME MEASURES CMD risk factors (obesity, insulin resistance, dyslipidemia, and hypertension) using Paralyzed Veterans of America SCI-specific guidelines. RESULTS Obesity was prevalent (82%) and co-occurred with most other risk factors present. Age increased odds for CMD diagnosis by 1.05 per year (P = 0.02) and was directly related to elevated body mass index (BMI, β = 0.42, P < 0.05), fasting glucose (β = 0.58, P < 0.01), and higher systolic blood pressure (β = 0.31, P < 0.10). In contrast, time since injury contributed to lower risk factor count (β = -0.29, P < 0.10) and higher HDL-C (β = 0.50, P < 0.01), and was not related to odds of CMD diagnosis. CONCLUSION While SCI is linked to an increased risk of CMD, age is associated with higher CMD risk. Increased SCI duration related to improvement in individual CMD risk factors but did not decrease overall risk for CMD diagnosis. SCI may not uniformly increase CMD risks and highlight a necessary focus on weight management for risk prevention.
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Affiliation(s)
- Hannah W. Mercier
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA
| | - Ryan Solinsky
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA
| | - J. Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA
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Desneves KJ, Kiss N, Daly RM, Abbott G, Ward LC. Longitudinal changes in body composition and diet after acute spinal cord injury. Nutrition 2024; 120:112345. [PMID: 38301395 DOI: 10.1016/j.nut.2023.112345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Spinal cord injury (SCI) is associated with low muscle mass and adiposity, however, to our knowledge, few studies have monitored the trajectory of changes over time. This study aimed to evaluate the timing, rate, magnitude, and site-specific changes in body composition and related changes in diet after SCI. METHODS We assessed 39 patients with SCI. The analysis included five women. Of the participants, 51% had American Spinal Injury Association Impairment Scale (AIS) criteria A/B (motor complete) injuries, 18% had AIS C (sensory/motor incomplete) injuries, and 31% had AIS D (motor incomplete) injuries. The mean age of the patients was 43.2 y. They were 48.1 d post-injury and had their weight, diet, and body composition (bioimpedance spectroscopy) assessed every 2 wk. RESULTS No significant linear changes were observed for any body composition measure. Total body fat mass (FM) changed 0.01 kg/2 wk when fitted to a quadratic model (P = 0.004), decreasing to week 15 and returning to baseline at week 28. Subgroup analysis revealed that arm lean tissue mass (LTM) increased in paraplegic versus tetraplegic participants (0.05 versus -0.01 kg/2 wk, P = 0.007). Participants with AIS A/B injuries lost FM (-0.17 kg; P = 0.010), whereas those with AIS C injuries gained appendicular LTM (ALTM; 0.15 kg; P = 0.017) and leg LTM (0.12 kg; P = 0.008) every 2 wk. Body composition remained stable in the AIS D group. Mean fortnightly changes were greater in the AIS A/B group than the C group for weight (mean difference -0.30 kg; P = 0.021), FM (-0.25 kg; P = 0.002), and leg LTM (-0.11 kg; P = 0.021) and AIS A/B versus D for FM (-0.42 kg; P = 0.013). Baseline energy and protein intakes were 2150 kcal (±741) and 102 g (±40) and decreased by 21.5 kcal (P = 0.016) and 1.3 g (P = 0.004) every 2 wk but were not associated with body composition changes. CONCLUSIONS Neurologic level and severity of SCI, but not changes in diet, were the main determinants of heterogeneous body composition changes.
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Affiliation(s)
- Katherine J Desneves
- Department of Nutrition and Dietetics, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia; Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia.
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia; Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia
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Slettahjell HB, Bastakis M, Biering-Sørensen F, Strøm V, Henriksen C. Defining malnutrition in persons with spinal cord injury - does the Global Criteria for Malnutrition work? Food Nutr Res 2024; 68:9989. [PMID: 38571922 PMCID: PMC10989229 DOI: 10.29219/fnr.v68.9989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background and aims Physiologic and metabolic changes following spinal cord injury (SCI) lead to an increased risk of malnutrition. The Global Leadership Initiative on Malnutrition (GLIM) is a three-step approach to diagnose malnutrition: 1) screening; 2) phenotypic and etiological criteria; and 3) malnutrition severity. The main aim of this study was to assess malnutrition in patients with SCI, according to the GLIM criteria. Methods Patients with SCI (≥ 18 years) admitted to rehabilitation were included. Anthropometrics, food intake, and inflammation were assessed on admission. Fat-free mass index (FFMI) was estimated from bioimpedance analysis. Malnutrition was diagnosed by the GLIM criteria, using the Malnutrition Universal Screening Tool (MUST) as the first step screening tool. Sensitivity and specificity analyses were performed. Results In total, 66 patients were assessed (50 men) with a mean age of 51.4 (± 17.4) years and median time since injury was 37.5 (10-450) days. The mean body mass index was 24.7 (± 4.2) kg/m2, and 1-month involuntary weight loss was 5.7 (± 4.4)%. FFMI for men was 17.3 (± 1.9) and for women 15.3 (± 1.6) kg/m2. Forty-one patients (62%) were malnourished according to the GLIM criteria: 27 moderately and 14 severely malnourished. MUST was not able to detect malnutrition risk of nine patients, giving a moderate agreement (kappa 0.66), with a sensitivity of 0.78 and a specificity of 0.92 compared to the GLIM diagnosis. Conclusions In this cross-sectional study, 62% of subacute SCI patients were malnourished according to the GLIM criteria. The screening tool MUST showed moderate agreement with the GLIM criteria and did not detect risk of all patients with a malnutrition diagnosis. The clinical implications of these findings need further investigation.
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Affiliation(s)
- Hanne Bjørg Slettahjell
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Maria Bastakis
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Fin Biering-Sørensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department for Brain- and Spinal Cord Injuries, Bodil Eskesen Center, Glostrup, Denmark
| | - Vegard Strøm
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
| | - Christine Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
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Holm NJ, Møller T, Schou LH, Biering-Sørensen F. Monitoring outcome measures for cardiometabolic disease during rehabilitation and follow-up in people with spinal cord injury. Spinal Cord 2024; 62:125-132. [PMID: 38326463 DOI: 10.1038/s41393-023-00956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/16/2023] [Accepted: 12/20/2023] [Indexed: 02/09/2024]
Abstract
STUDY DESIGN Controlled pragmatic intervention with follow-up. OBJECTIVES To describe cardiometabolic risk outcomes after a pragmatic intervention implemented into standard spinal cord injury (SCI) rehabilitation. SETTING Inpatient SCI rehabilitation in East-Denmark. PARTICIPANTS Inpatients, >18 years, having sustained a SCI within the last 12 months at admission to rehabilitation, regardless of etiology, neurological level or completeness of the lesion or mobility status. METHODS Patient education on health promotion was guided by evidence and included feedback on peak oxygen uptake (VO2peak) (primary outcome measure), body mass index (BMI), Dual energy X-ray absorptiometry and metabolic profile (secondary outcome measures). Paired t-tests, non-parametric tests and Analysis of Variance (ANOVA) were used for analyzes. VO2peak and BMI were compared to historical data. RESULTS VO2peak increased significantly from admission to discharge but did not exceed historical data despite a minimal clinical important difference. BMI decreased significantly during rehabilitation (p < 0.001) followed by a significant increase after discharge (p = 0.006). There was a trend that people with American Spinal Injury Association Impairment Scale (AIS) D SCI increased lean mass to nearly normal values. Criteria for pre-diabetes or diabetes were present in 28.5% and dyslipidemia in 45% of the participants 44.2 days after time of injury. CONCLUSIONS Despite improvements during rehabilitation, outcome measures were worse than recommended, and most outcome measures worsened at follow up, even in people with an AIS D SCI. Meaningful support regarding exercise and diet when tackling altered life circumstances is needed after discharge.
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Affiliation(s)
- Nicolaj J Holm
- Rigshospitalet, Neuroscience Center, Department for Spinal Cord and Brain Injuries, Hornbæk, Denmark.
| | - Tom Møller
- University Hospitals Centre for Health Care Research, University hospital Copenhagen, Rigshospitalet, Denmark
| | - Lone H Schou
- University College Copenhagen, Department of Nursing and Nutrition, Copenhagen, Denmark
| | - Fin Biering-Sørensen
- Rigshospitalet, Neuroscience Center, Department for Spinal Cord and Brain Injuries, Hornbæk, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Fallah N, Noonan VK, Thorogood NP, Kwon BK, Kopp MA, Schwab JM. Effect of body mass index on survival after spinal cord injury. Front Neurol 2024; 14:1269030. [PMID: 38344110 PMCID: PMC10853461 DOI: 10.3389/fneur.2023.1269030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/27/2023] [Indexed: 05/12/2024] Open
Abstract
Introduction Increased mortality after acute and chronic spinal cord injury (SCI) remains a challenge and mandates a better understanding of the factors contributing to survival in these patients. This study investigated whether body mass index (BMI) measured after acute traumatic SCI is associated with a change in mortality. Methods A prospective longitudinal cohort study was conducted with 742 patients who were admitted to the Acute Spine Unit of the Vancouver General Hospital between 2004 and 2016 with a traumatic SCI. An investigation of the association between BMI on admission and long-term mortality was conducted using classification and regression tree (CART) and generalized additive models (spline curves) from acute care up to 7.7 years after SCI (chronic phase). Multivariable models were adjusted for (i) demographic factors (e.g., age, sex, and Charlson Comorbidity Index) and (ii) injury characteristics (e.g., neurological level and severity and Injury Severity Score). Results After the exclusion of incomplete datasets (n = 602), 643 patients were analyzed, of whom 102 (18.5%) died during a period up to 7.7 years after SCI. CART identified three distinct mortality risk groups: (i) BMI: > 30.5 kg/m2, (ii) 17.5-30.5 kg/m2, and (iii) < 17.5 kg/m2. Mortality was lowest in the high BMI group (BMI > 30.5 kg/m2), followed by the middle-weight group (17.5-30.5 kg/m2), and was highest in the underweight group (BMI < 17.5 kg/m2). High BMI had a mild protective effect against mortality after SCI (hazard ratio 0.28, 95% CI: 0.09-0.88, p = 0.029), concordant with a modest "obesity paradox". Moreover, being underweight at admission was a significant risk factor for mortality up to 7.7 years after SCI (hazard ratio 5.5, 95% CI: 2.34-13.17, p < 0.001). Discussion Mortality risk (1 month to 7.7 years after SCI) was associated with differences in BMI at admission. Further research is needed to better understand the underlying mechanisms. Given an established association of BMI with metabolic determinants, these results may suggest unknown neuro-metabolic pathways that are crucial for patient survival.
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Affiliation(s)
- Nader Fallah
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Nancy P. Thorogood
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Marcel A. Kopp
- Department of Neurology and Experimental Neurology, Clinical and Experimental Spinal Cord Injury Research, Charité – Universitätsmedizin Berlin, Berlin, Germany
- QUEST-Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Jan M. Schwab
- Department of Neurology and Experimental Neurology, Clinical and Experimental Spinal Cord Injury Research, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Spinal Cord Injury Division, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
- Belford Center for Spinal Cord Injury, Departments of Physical Medicine and Rehabilitation and Neuroscience, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
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Raguindin PF, Mueller G, Stoyanov J, Eriks-Hoogland I, Jordan X, Stojic S, Hund-Georgiadis M, Muka T, Stucki G, Glisic M. Burden of Cardiovascular Risk in Individuals With Spinal Cord Injury and Its Association With Rehabilitation Outcomes: Results From the Swiss Spinal Cord Injury Cohort. Am J Phys Med Rehabil 2023; 102:1043-1054. [PMID: 37204918 PMCID: PMC10662615 DOI: 10.1097/phm.0000000000002276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVES The aims of the study are to determine the cardiovascular risk burden rehabilitation discharge and to explore the association between recovery during rehabilitation and cardiovascular disease risk profile. METHODS We included adults without cardiovascular disease admitted for rehabilitation. We evaluated rehabilitation outcomes on admission and discharge. Cardiovascular disease risk profile was assessed by Framingham risk score, high-density lipoprotein, and fasting glucose level. RESULTS We analyzed data from 706 participants (69.6% men) with a median age of 53.5 yrs. The median time since injury was 14 days, and the admission length was 5.2 months. Majority had paraplegia (53.3%) and motor incomplete injury (53.7%). One third of the cohort had high cardiovascular risk profile before discharge. At discharge, poorer anthropometric measures were associated with higher Framingham risk score and lower high-density lipoprotein levels. Individuals with higher forced vital capacity (>2.72 l) and peak expiratory flow (>3.4 l/min) had 0.16 mmol/l and 0.14 mmol/l higher high-density lipoprotein compared with those with lower respiratory function, respectively. Individuals with higher mobility score (>12.5) and functional independence score (>74) had 0.21 and 0.18 mmol/l higher high-density lipoprotein compared with those with lower scores. CONCLUSIONS There is high cardiometabolic syndrome burden and cardiovascular disease risk profile upon rehabilitation discharge. Higher respiratory function, mobility, and overall independence were associated with better cardiovascular disease risk profile, although with study design limitations and short follow-up. Future studies should explore whether rehabilitation outcomes could be used to prioritize screening. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon reading this journal article, the reader is expected to: (1) Determine the burden of cardiometabolic disease in the early phase of spinal cord injury (SCI); (2) Differentiate the proposed SCI cutoff for high-risk obesity from the able-bodied population; and (3) Increase physicians' acuity for detecting cardiometabolic disease in their practice. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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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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Tóth B, Dénes Z, Németh M, Fazekas G. Changes in skeletal muscle mass index and fat mass index during rehabilitation for traumatic brain injury and stroke measured by bioelectrical impedance analysis. Int J Rehabil Res 2023; 46:264-269. [PMID: 37334827 DOI: 10.1097/mrr.0000000000000587] [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: 06/21/2023]
Abstract
Although malnutrition may negatively impact the outcomes of rehabilitation and increase the cost of care, there are still no valid nutritional assessment methods appropriate for specific groups of patients undergoing rehabilitation. This study aimed to determine if a multifrequency bioelectrical impedance is suitable for monitoring the changes in body composition of brain-injured patients for whom individualized nutritional goals were set during rehabilitation. Fat mass index (FMI) and skeletal muscle mass index (SMMI) were examined by Seca mBCA515 or portable Seca mBCA525 device within 48 h of admission and before discharge in 11 traumatic brain injury (TBI) and 11 stroke patients with admission Nutritional Risk Screening 2002 scores ≥2. The changes in outcomes and plausible interactions were examined between the admission values and the values estimated for the 18th day (minimum length of stay in the sample) using a repeated measure mixed-sample analysis of covariance. In patients with low FMI at admission (mainly younger, TBI patients, with longer ICU stay), there was no change over time whereas, in those with high admission FMI (older, stroke patients, with shorter ICU stay), a decrease was observed (significant interaction F(1,19) = 9.224 P = 0.007 Part. η² = 0.327). The SMMI significantly increased over time (F(1,19) = 5.202 P = 0.034 Part. η² = 0.215) independently of gender, age, days spent in ICU and cause of brain injury. Our results suggest that bioelectrical impedance analysis is feasible and informative for monitoring the changes in body composition during rehabilitation, which also requires consideration of demographic and pre-rehabilitation characteristics.
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Affiliation(s)
- Babett Tóth
- Rehabilitation Department of Brain injuries, Department for Rehabilitation post Stroke, Department of Alimentation and Dietetics, National Institute of Locomotor Diseases and Disabilities/National Institute for Medical Rehabilitation
| | - Zoltán Dénes
- Rehabilitation Department of Brain injuries, Department for Rehabilitation post Stroke, Department of Alimentation and Dietetics, National Institute of Locomotor Diseases and Disabilities/National Institute for Medical Rehabilitation
- Department of Rehabilitation Medicine, Semmelweis University, Budapest
| | - Mariann Németh
- Rehabilitation Department of Brain injuries, Department for Rehabilitation post Stroke, Department of Alimentation and Dietetics, National Institute of Locomotor Diseases and Disabilities/National Institute for Medical Rehabilitation
- Department of Rehabilitation Medicine, Semmelweis University, Budapest
| | - Gábor Fazekas
- Rehabilitation Department of Brain injuries, Department for Rehabilitation post Stroke, Department of Alimentation and Dietetics, National Institute of Locomotor Diseases and Disabilities/National Institute for Medical Rehabilitation
- University of Szeged, Szeged, Hungary
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Nevin AN, Urquhart S, Atresh SS, Geraghty TJ, Walter E, Ryan EG, Vivanti A, Ward LC, Hickman IJ. A longitudinal analysis of resting energy expenditure and body composition in people with spinal cord injury undergoing surgical repair of pressure injuries: a pilot study. Eur J Clin Nutr 2023; 77:386-392. [PMID: 36477671 DOI: 10.1038/s41430-022-01248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data informing energy needs of people with spinal cord injury (SCI) and pressure injuries are scarce, the impact of surgical repair unknown, and the role of body composition in healing unexplored. The study aims were to investigate resting energy expenditure (REE) over the course of pressure injury surgical repair, compare with available energy prediction equations, and explore associations between body composition and wound healing. METHODS Indirect calorimetry measured REE pre-surgery, post-surgery, at suture removal and hospital discharge. A clinically significant change was defined as +/-10% difference from pre-surgery. Eight SCI-specific energy prediction equations were compared to pre-surgery REE. Wound breakdown (Yes/No), weight, waist circumference (WC), and body composition (fat mass [FM], fat-free mass [FFM], bioimpedance spectroscopy) were measured. RESULTS Twenty people underwent pressure injury surgical repair (95% male, mean age 56 ± 12 years, 70% paraplegia). Between pre-surgery and discharge, mean REE increased (+118 kcal/d, p = 0.005), but with <10% change at any timepoint. An energy prediction equation incorporating FFM showed greatest agreement (rc = 0.779, 95% CI: 0.437, 0.924). Those with wound breakdown (65%) had a higher weight (12.7 kg, 95% CI: -4.0, 29.3), WC (17.8 cm, 95% CI: -5.1, 40.7), and FM % (36.0% [IQR 31.8, 40.2] vs 26.0% [IQR 15.6, 41.3]) than those without wound breakdown, although statistical significance was not reached. CONCLUSION The presence of pressure injuries and subsequent surgical repair did not impact REE and energy prediction equations incorporating FFM performed best. While not statistically significant, clinically important differences in body composition were observed in those with wound breakdown.
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Affiliation(s)
- Amy N Nevin
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia. .,The Hopkins Centre - Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Brisbane, QLD, Australia. .,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Susan Urquhart
- Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Sridhar S Atresh
- The Hopkins Centre - Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Timothy J Geraghty
- The Hopkins Centre - Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Brisbane, QLD, Australia.,Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Elizabeth Walter
- Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Elizabeth G Ryan
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Angela Vivanti
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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11
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Flury I, Mueller G, Perret C. The risk of malnutrition in patients with spinal cord injury during inpatient rehabilitation-A longitudinal cohort study. Front Nutr 2023; 10:1085638. [PMID: 36755991 PMCID: PMC9899810 DOI: 10.3389/fnut.2023.1085638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Background and aim Patients with spinal cord injury (SCI) show an increased risk of malnutrition. Studies found that about 50% of patients with a recent SCI are affected by malnutrition when they enter a rehabilitation institution. However, there is a lack of data during the course and at discharge of initial rehabilitation as well as missing knowledge about the factors promoting such a risk. The aim of this study was to assess the risk of malnutrition in individuals with SCI 3 months post injury and at the end of inpatient rehabilitation and to identify factors associated with a high risk of malnutrition. Methods Retrospective, monocentric, longitudinal cohort study, using the data set of the Swiss Spinal Cord Injury Cohort Study and additional data from the patients' medical records. Individuals with SCI were assessed for the risk of malnutrition using the Spinal Nutrition Screening Tool 3 months post injury and at discharge from initial inpatient rehabilitation. Odds ratios (OR) for potential risk parameters were calculated. Results Of the 252 participants included, 62% were at risk for malnutrition 3 months post injury and 40% at discharge (p = 0.000). Moderate to high risk of malnutrition was found regardless of age and BMI. The highest odds for an increased risk at 3 months post injury was identified in ventilator-dependent persons (OR 10.2). At discharge from inpatient rehabilitation, pressure injury (OR 16.3) was the most prominent risk factor. Conclusion In the population with SCI the risk of malnutrition is widespread during inpatient rehabilitation, but also at discharge. Ventilated persons and persons with pressure injuries are clear risk groups and need special attention. Based on these findings and the known negative impact of malnutrition on clinical outcomes, the awareness of malnutrition should be increased in the population with SCI. Therefore, a regular and standardized screening of the malnutrition risk is highly recommended.
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Affiliation(s)
- Irene Flury
- Nutritional Therapy Department, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Gabi Mueller
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Claudio Perret
- Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland,*Correspondence: Claudio Perret,
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12
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Mohammadi H, Parastouei K, Rostami H, Fadel A. The association between dietary inflammatory index and psychological profile among men with spinal cord injury. J Spinal Cord Med 2022; 45:940-945. [PMID: 33905314 PMCID: PMC9662030 DOI: 10.1080/10790268.2021.1905977] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The present study was designed to examine the relationship between the dietary inflammatory index (DII) and depression, anxiety and stress in Iranian men with spinal cord injury (SCI). DESIGN Cross-sectional study. SETTING Mottahary SCI clinic, Isfahan, Iran. PARTICIPANTS The current study was conducted on 150 men with SCI aged 40-65 years. OUTCOME MEASURES Dietary data were collected using a semi-quantitative 148 item food frequency questionnaire (FFQ). The Depression, Anxiety, Stress Scale-21 (DASS-21) was used to assess the psychological profile of the participants. RESULTS The DII score ranged from -3.62 to 4.02. Overall, 34% of study participants had at least mild levels of depression and anxiety symptoms and 25% had at least mild levels of stress symptoms. A one-unit increase in the DII was significantly associated with higher scores of depressive symptoms (β = 1.31, 95% CI 0.44-2.18; P = 0.003). Also, a one-unit increase in the DII was associated with higher odds of having at least mild depressive symptoms (OR = 1.77, 95% CI 1.17, 2.67; P = 0.007). No significant association was found between the DII and anxiety and stress. CONCLUSION The present study indicated that a higher DII score is associated with higher odds of depressive symptoms in men with SCI. These initial findings highlight the crucial role of the inflammatory potential of diet in the mental health of subjects with SCI. Future prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Hamed Mohammadi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Karim Parastouei
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran,Correspondence to: Karim Parastouei, Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, PO Box 1435915371, Tehran, Iran.
| | - Hosein Rostami
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abdulmnannan Fadel
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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13
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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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14
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Raguindin PF, Stoyanov J, Eriks-Hoogland I, Stucki G, Jordan X, Schubert M, Franco OH, Muka T, Glisic M. Cardiometabolic risk profiling during spinal cord injury rehabilitation: A longitudinal analysis from Swiss Spinal Cord Injury cohort (SwiSCI). PM R 2022. [PMID: 35648677 DOI: 10.1002/pmrj.12857] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early screening is important in individuals with spinal cord injury (SCI) as they were deemed high-risk for cardiometabolic diseases. Few studies explored changes in cardiometabolic risk profile in the early phase of the injury. Thus, it remains unclear how early the cardiometabolic status deteriorates after injury. OBJECTIVE We determined the longitudinal changes in the cardiometabolic risk profile and examined the association between injury characteristics and cardiometabolic status in subacute SCI. SETTING Multicenter Swiss Spinal Cord Injury Cohort. PARTICIPANTS Adults with traumatic SCI without history of cardiovascular disease or type 2 diabetes. MAIN OUTCOME MEASURES Blood pressure (BP), lipid profile, fasting glucose, waist circumference (WC), weight, body mass index (BMI) and Framingham risk score (FRS) were compared across time and according to the injury characteristics. RESULTS We analyzed the data of 258 individuals with traumatic SCI (110 tetraplegia and 148 paraplegia, 122 motor complete and 136 incomplete). The median age was 50 years (IQR 32-60), with 76.36% (n=197) of the population being male. The median rehabilitation duration was 5.5 months (IQR 3.2-7.1). At admission to rehabilitation, fully-adjusted linear regression models showed higher baseline weight (β 0.06, 95% CI 0.005, 0.11), systolic BP (β 0.05, 95% CI 0.008, 0.09), diastolic BP (β 0.05 95% CI 0.004, 0.10), and triglycerides (β 0.27 95% CI 0.13, 0.42) in paraplegia than tetraplegia. Systolic BP, diastolic BP, HDL-C were higher in incomplete than complete injury. In our main analysis, we observed an increase in cholesterol and HDL-C and lipid ratio when comparing the beginning and end of rehabilitation. Individuals with paraplegia had a higher increase in BMI than tetraplegia, while no differences in other cardiometabolic risk factors were detected when comparing motor incomplete and complete injury. Trajectories of each participant showed that the majority of individuals with SCI decreased FRS score at follow-up compared to baseline and no significant changes in prevalence of cardiometabolic syndrome were observed. At discharge, one-third of study participants were classified as moderate to high risk of CVD, 64% were overweight, and 39.45% had cardiometabolic syndrome. CONCLUSION We observed a modest improvement in lipid profile and FRS during the first inpatient rehabilitation hospitalization. Injury characteristics, such as level and completeness, were not associated with changes in cardiometabolic risk factors in the subacute phase of the injury. Despite this, a significant proportion of study participants remained at risk of cardiometabolic disease at discharge, suggesting that early cardiometabolic preventive strategies may be initiated as early as during the first inpatient rehabilitation hospitalization. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | | | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | - Xavier Jordan
- Clinique Romande de Réadaptation, Avenue du Grand-Champsec 90, 1950 Sion, Switzerland
| | - Martin Schubert
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse 340, Zurich, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
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15
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Graham ZA, DeBerry JJ, Cardozo CP, Bamman MM. SS-31 does not prevent or reduce muscle atrophy 7 days after a 65 kdyne contusion spinal cord injury in young male mice. Physiol Rep 2022; 10:e15266. [PMID: 35611788 PMCID: PMC9131615 DOI: 10.14814/phy2.15266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 05/02/2023] Open
Abstract
Spinal cord injury (SCI) leads to major reductions in function, independent living, and quality of life. Disuse and paralysis from SCI leads to rapid muscle atrophy, with chronic muscle loss likely playing a role in the development of the secondary metabolic disorders often seen in those with SCI. Muscle disuse is associated with mitochondrial dysfunction. Previous evidence has suggested targeting the mitochondria with the tetrapeptide SS-31 is beneficial for muscle health in preclinical models that lead to mitochondrial dysfunction, such as cast immobilization or burn injury. We gave young male mice a sham (n = 8) or 65 kdyne thoracic contusion SCI with (n = 9) or without (n = 9) daily administration of 5.0 mg/kg SS-31. Hindlimb muscle mass and muscle bundle respiration were measured at 7 days post-SCI and molecular targets were investigated using immunoblotting, RT-qPCR, and metabolomics. SS-31 did not preserve body mass or hindlimb muscle mass 7 days post-SCI. SS-31 had no effect on soleus or plantaris muscle bundle respiration. SCI was associated with elevated levels of protein carbonylation, led to reduced protein expression of activated DRP1 and reductions in markers of mitochondrial fusion. SS-31 administration did result in reduced total DRP1 expression, as well as greater expression of inhibited DRP1. Gene expression of proinflammatory cytokines and their receptors were largely stable across groups, although SS-31 treatment led to greater mRNA expression of IL1B, TNF, and TNFRSF12A. In summation, SS-31 was not an efficacious treatment acutely after a moderate thoracic contusion SCI in young male mice.
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Affiliation(s)
- Zachary A. Graham
- Research ServiceBirmingham VA Medical CenterBirminghamAlabamaUSA
- Department of Cell, Developmental, and Integrative BiologyUABBirminghamAlabamaUSA
| | - Jennifer J. DeBerry
- Department of Anesthesiology and Perioperative MedicineUABBirminghamAlabamaUSA
| | - Christopher P. Cardozo
- Center for the Medical Consequences of Spinal Cord InjuryBronxNew YorkUSA
- Medical ServiceJames J. Peters VA Medical CenterBronxNew YorkUSA
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Marcas M. Bamman
- Research ServiceBirmingham VA Medical CenterBirminghamAlabamaUSA
- Department of Cell, Developmental, and Integrative BiologyUABBirminghamAlabamaUSA
- UAB Center for Exercise MedicineBirminghamAlabamaUSA
- Florida Institute for Human and Machine CognitionPensacolaFloridaUSA
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16
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Evaluation of the Cardiometabolic Disorders after Spinal Cord Injury in Mice. BIOLOGY 2022; 11:biology11040495. [PMID: 35453695 PMCID: PMC9027794 DOI: 10.3390/biology11040495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/16/2022]
Abstract
Changes in cardiometabolic functions contribute to increased morbidity and mortality after chronic spinal cord injury. Despite many advancements in discovering SCI-induced pathologies, the cardiometabolic risks and divergences in severity-related responses have yet to be elucidated. Here, we examined the effects of SCI severity on functional recovery and cardiometabolic functions following moderate (50 kdyn) and severe (75 kdyn) contusions in the thoracic-8 (T8) vertebrae in mice using imaging, morphometric, and molecular analyses. Both severities reduced hindlimbs motor functions, body weight (g), and total body fat (%) at all-time points up to 20 weeks post-injury (PI), while only severe SCI reduced the total body lean (%). Severe SCI increased liver echogenicity starting from 12 weeks PI, with an increase in liver fibrosis in both moderate and severe SCI. Severe SCI mice showed a significant reduction in left ventricular internal diameters and LV volume at 20 weeks PI, associated with increased LV ejection fraction as well as cardiac fibrosis. These cardiometabolic dysfunctions were accompanied by changes in the inflammation profile, varying with the severity of the injury, but not in the lipid profile nor cardiac or hepatic tyrosine hydroxylase innervation changes, suggesting that systemic inflammation may be involved in these SCI-induced health complications.
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17
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Hoevenaars D, Yocarini IE, Paraschiakos S, Holla JFM, de Groot S, Kraaij W, Janssen TWJ. Accuracy of Heart Rate Measurement by the Fitbit Charge 2 During Wheelchair Activities in People With Spinal Cord Injury: Instrument Validation Study. JMIR Rehabil Assist Technol 2022; 9:e27637. [PMID: 35044306 PMCID: PMC8811691 DOI: 10.2196/27637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 11/12/2021] [Accepted: 11/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background Heart rate (HR) is an important and commonly measured physiological parameter in wearables. HR is often measured at the wrist with the photoplethysmography (PPG) technique, which determines HR based on blood volume changes, and is therefore influenced by blood pressure. In individuals with spinal cord injury (SCI), blood pressure control is often altered and could therefore influence HR accuracy measured by the PPG technique. Objective The objective of this study is to investigate the HR accuracy measured with the PPG technique with a Fitbit Charge 2 (Fitbit Inc) in wheelchair users with SCI, how the activity intensity affects the HR accuracy, and whether this HR accuracy is affected by lesion level. Methods The HR of participants with (38/48, 79%) and without (10/48, 21%) SCI was measured during 11 wheelchair activities and a 30-minute strength exercise block. In addition, a 5-minute seated rest period was measured in people with SCI. HR was measured with a Fitbit Charge 2, which was compared with the HR measured by a Polar H7 HR monitor used as a reference device. Participants were grouped into 4 groups—the no SCI group and based on lesion level into the <T5 (midthoracic and lower) group, T5-T1 (high-thoracic) group, and >T1 (cervical) group. Mean absolute percentage error (MAPE) and concordance correlation coefficient were determined for each group for each activity type, that is, rest, wheelchair activities, and strength exercise. Results With an overall MAPEall lesions of 12.99%, the accuracy fell below the standard acceptable MAPE of –10% to +10% with a moderate agreement (concordance correlation coefficient=0.577). The HR accuracy of Fitbit Charge 2 seems to be reduced in those with cervical lesion level in all activities (MAPEno SCI=8.09%; MAPE<T5=11.16%; MAPET1−T5=10.5%; and MAPE>T1=20.43%). The accuracy of the Fitbit Charge 2 decreased with increasing intensity in all lesions (MAPErest=6.5%, MAPEactivity=12.97%, and MAPEstrength=14.2%). Conclusions HR measured with the PPG technique showed lower accuracy in people with SCI than in those without SCI. The accuracy was just above the acceptable level in people with paraplegia, whereas in people with tetraplegia, a worse accuracy was found. The accuracy seemed to worsen with increasing intensities. Therefore, high-intensity HR data, especially in people with cervical lesions, should be used with caution.
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Affiliation(s)
- Dirk Hoevenaars
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands
| | - Iris E Yocarini
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
| | - Stylianos Paraschiakos
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands.,Molecular Epidemiology, Department of Biomedical Data Science, Leiden University Medical Center, Leiden, Netherlands
| | - Jasmijn F M Holla
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands.,Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, Netherlands.,Center for Adapted Sports, Amsterdam Institute of Sport Science, Amsterdam, Netherlands
| | - Sonja de Groot
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands.,Center for Adapted Sports, Amsterdam Institute of Sport Science, Amsterdam, Netherlands
| | - Wessel Kraaij
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
| | - Thomas W J Janssen
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands.,Center for Adapted Sports, Amsterdam Institute of Sport Science, Amsterdam, Netherlands
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18
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An observational study on body mass index during rehabilitation and follow-up in people with spinal cord injury in Denmark. Spinal Cord 2022; 60:157-162. [PMID: 34975155 DOI: 10.1038/s41393-021-00730-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Observational study OBJECTIVE: To describe body mass index (BMI) during rehabilitation in people with a newly sustained spinal cord injury (SCI). SETTING Inpatient SCI rehabilitation in Denmark. PARTICIPANTS Inpatients, >18 years, having sustained a SCI within the last 12 months at admission to primary rehabilitation, inclusive of various SCI etiology, neurological level, completeness of the lesion or mobility status. METHODS Measures of BMI were obtained at admission and discharge as part of standard care. At one SCI center measures of BMI were sampled at follow up 9.5 months after discharge as well. BMI was described by mean and standard deviation (SD). Paired t-test was used to test difference in BMI between admission and discharge. Repeated measures Analysis of Variance (ANOVA) was used for analyzing BMI deriving from three time points. RESULTS Overall BMI was stable with no change (25.4 kg/m2 at admission and 25.6 kg/m2 at discharge) during rehabilitation at the two national centers. In participants with an American Spinal Injury Association (ASIA) Impairment Scale (AIS) D classification, BMI was higher during rehabilitation compared to the other groups and increased significantly (p = 0.008) from discharge to follow up. CONCLUSIONS Overall BMI was stable but higher than recommended in people with SCI undergoing rehabilitation at the two national centers in Denmark. Participants with an AIS D SCI were obese according to SCI adjusted BMI and the World Health Organization (WHO) recommendations during rehabilitation and at follow up.
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19
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Chiu TT, Lee KZ. Impact of cervical spinal cord injury on the relationship between the metabolism and ventilation in rats. J Appl Physiol (1985) 2021; 131:1799-1814. [PMID: 34647826 DOI: 10.1152/japplphysiol.00472.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cervical spinal cord injury typically results in respiratory impairments. Clinical and animal studies have demonstrated that respiratory function can spontaneously and partially recover over time after injury. However, it remains unclear whether respiratory recovery is associated with alterations in metabolism. The present study was designed to comprehensively examine ventilation and metabolism in a rat model of spinal cord injury. Adult male rats received sham (i.e., laminectomy) or unilateral mid-cervical contusion injury (height of impact rod: 6.25 or 12.5 mm). Breathing patterns and whole body metabolism (O2 consumption and CO2 production) were measured using a whole body plethysmography system conjugated with flow controllers and gas analyzer at the acute (1 day postinjury), subchronic (2 wk postinjury), and chronic (8 wk postinjury) injury stages. The results demonstrated that mid-cervical contusion caused a significant reduction in the tidal volume. Although the tidal volume of contused animals can gradually recover, it remains lower than that of uninjured animals at the chronic injury stage. Although O2 consumption and CO2 production were similar between uninjured and contused animals at the acute injury stage, these two metabolic parameters were significantly reduced in contused animals at the subchronic to chronic injury stages. Additionally, the relationships between ventilation, metabolism, and body temperature were altered by cervical spinal cord injury. These results suggest that cervical spinal cord injury causes a complicated reconfiguration of ventilation and metabolism that may enable injured animals to maintain a suitable homeostasis for adapting to the pathophysiological consequences of injury.NEW & NOTEWORTHY Ventilation and metabolism are tightly coupled to maintain appropriate energy expenditure under physiological conditions. Our findings demonstrate that cervical spinal cord injury results in the differential reduction of ventilation and metabolism at the various injury stages and leads to alterations in the relationship between ventilation and metabolism. These results from an animal model provide fundamental knowledge for understanding how cervical spinal cord injury impacts energy homeostasis.
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Affiliation(s)
- Tzu-Ting Chiu
- Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Kun-Ze Lee
- Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan
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20
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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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21
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Bassett BL, Hostetler JA, Leone E, Shea CP, Barbeau BD, Lonati GL, Panike AL, Honaker A, Ward-Geiger LI. Quantifying sublethal Florida manatee-watercraft interactions by examining scars on manatee carcasses. ENDANGER SPECIES RES 2020. [DOI: 10.3354/esr01075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A leading human-related threat to the Florida manatee Trichechus manatus latirostris is collisions with watercraft, which account for 20-25% of reported mortalities. Quantitative threat assessments do not include information on all known manatee-watercraft interactions. These interactions often result in sublethal wounding, usually leaving multiple fresh external wounds in a variety of patterns. These wounds then resolve into well-healed scars. We characterized and quantified watercraft-related scar patterns (1 pattern = 1 strike event) on 2935 nonperinatal carcasses (>150 cm total length) that were recovered from 2007 through 2016 to compare the number of patterns by life stage, sex, and population region and across years. We used generalized linear mixed models to examine the effects of several factors on the probability carcasses having scars and on the number of scar patterns per carcass. The models indicated that approximately 96% of adults, approximately 70% of subadults, and approximately 34% of calves had watercraft-related scars. The raw data showed that 1 in 4 adults had been hit 10 or more times; 5 adult carcasses bore evidence of 40 or more strikes. On average, adult females had more scar patterns than did adult males. Manatees on Florida’s west coast had more scar patterns than did those on the east coast, while carcasses from the less populated Everglades had significantly fewer scar patterns than did those from the rest of the state. These results improve our understanding of the extent of sublethal injury of the Florida manatee caused by boat strikes.
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Affiliation(s)
- BL Bassett
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL 33701, USA
| | - JA Hostetler
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL 33701, USA
| | - E Leone
- Center for Biostatistics and Modeling, Information Science and Management, Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, Gainesville, FL 32653, USA
| | - CP Shea
- Center for Biostatistics and Modeling, Information Science and Management, Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL 33701, USA
| | - BD Barbeau
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL 33701, USA
| | - GL Lonati
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL 33701, USA
- Department of Biological Sciences, University of New Brunswick Saint John, Saint John, New Brunswick E2L 4L5, Canada
| | - AL Panike
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL 33701, USA
| | - A Honaker
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL 33701, USA
| | - LI Ward-Geiger
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL 33701, USA
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Desneves KJ, Panisset MG, Galea MP, Kiss N, Daly RM, Ward LC. Comparison of segmental lean tissue mass in individuals with spinal cord injury measured by dual energy X-ray absorptiometry and predicted by bioimpedance spectroscopy. Spinal Cord 2020; 59:730-737. [PMID: 33077901 DOI: 10.1038/s41393-020-00568-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Observational. OBJECTIVES To compare two methods for predicting segmental (arms, legs, trunk) lean tissue mass (LTM: non-bone fat-free mass) from bioimpedance spectroscopy (BIS) against LTM measured from dual energy X-ray absorptiometry (DXA) in individuals with acute spinal cord injury (SCI). SETTING Austin Health Victorian Spinal Cord Service, Victoria, Australia. METHODS Fourteen participants (two female), within 8 weeks of traumatic SCI had BIS measured following an overnight fast and within 24 h of DXA scanning. Total body fat-free mass (FFM, body weight minus fat mass) and segmental LTM were predicted from BIS using manufacturer's proprietary software and a previously established SCI-specific prediction method. Appendicular LTM (ALM) was calculated from the sum of the LTM of the arms and legs. Agreement and strength of relationships with DXA for predicted LTM measures using both approaches were assessed using Lin's concordance coefficient and limits of agreement analysis (LOA). RESULTS The BIS proprietary method performed better than the SCI-specific prediction method in predicting DXA LTM, demonstrating substantial concordance for total body FFM (rc = 0.80), ALM (rc = 0.78), arm (rc = 0.76) and leg LTM (rc = 0.65) and a smaller bias and LOA for ALM (+0.8 vs. -3.4 kg; LOA -4.9-6.4 vs. -11.9-5.1 kg), arm (+0.02 vs. -0.3 kg; LOA -1.1-1.1 kg vs. -2.2-1.6 kg) and leg (+0.4 vs. -1.4 kg; LOA -2.0-2.8 vs. -5.6-2.8) LTM. CONCLUSIONS BIS can be used to accurately predict total body FFM, segmental LTM and ALM in individuals with acute SCI.
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Affiliation(s)
- Katherine J Desneves
- Department of Nutrition and Dietetics, Austin Health, Heidelberg, VIC, Australia. .,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia.
| | - Maya G Panisset
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Mary P Galea
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia
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Holm NJ, Møller T, Adamsen L, Dalsgaard LT, Biering-Sorensen F, Schou LH. Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge- protocol for a prospective national cohort study and a preintervention- postintervention study. BMJ Open 2019; 9:e030310. [PMID: 31892644 PMCID: PMC6955524 DOI: 10.1136/bmjopen-2019-030310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/24/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) predisposes those who suffer from it to physical inactivity and weight gain; consequently, death due to cardiovascular diseases is more frequent among people with SCI than in the general population. The literature documents a consensus about an interdisciplinary multimodal approach for the prevention and treatment of cardiovascular risk factors including overweight and obesity in people with SCI, focusing on diet, physical activity (PA) and behavioural interventions. This study will investigate implementation of recommendations from a recent clinical practice guideline for identification and management of cardiometabolic risk after SCI through multimodal patient education in a subacute clinical setting. METHODS AND ANALYSIS All patients who are aged 18 years or older with an SCI within the previous 12 months and admitted to highly specialised rehabilitation are included, regardless of SCI aetiology or neurological level. A primary study designed as a controlled, pragmatic, preintervention- postintervention study with 6-month follow-up evaluates the effect of the clinical intervention; a prospective national cohort study on body mass index (BMI) serves as a historical control. The intervention consists of a standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet that begins at the outset of primary SCI rehabilitation and is integrated into existing settings and workflows. Outcome measures are collected at admission, discharge and 6 months after discharge and include peak oxygen uptake (VO2peak) (primary outcome), BMI, body composition, metabolic profile, neurological status, level of functioning, depression, quality of life, objective PA (accelerometry), self-reported PA, self-assessed PA ability, shared decision making, and dietary habits. Test-retest reliability of four VO2peak test protocols are investigated, as is test-retest reliability of a multisensor accelerometer in a rehabilitation setting. ETHICS AND DISSEMINATION The project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10 July 2018 (Journal-nr.: H-18018325). The principal investigator obtains informed consent from all participants. The interventions in the project are closely related to existing rehabilitation care, and the risk of pain and discomfort is considered modest. Any unintended events related to the elements of the intervention are reported, according to existing regional procedures. Data are stored in a secure web-based database (Redcap). The primary study and prospective cohort study are registered at Clinicaltrials.gov. Positive and negative results will be submitted to relevant scientific journals related to SCI for publication. Important protocol modifications are reported to the Committees on Health Research Ethics in the Capital Region of Denmark. TRIAL REGISTRATION NUMBERS NCT03689023 and NCT03369080.
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Affiliation(s)
- Nicolaj Jersild Holm
- Neuroscience Center, Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark
| | - Tom Møller
- Department 9701, The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lis Adamsen
- Department 9701, The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Line Trine Dalsgaard
- Neuroscience Center, Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark
| | - Fin Biering-Sorensen
- Neuroscience Center, Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark
| | - Lone Helle Schou
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
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Influence of cervical spinal cord injury on thermoregulatory and cardiovascular responses in the human body: Literature review. J Clin Neurosci 2019; 69:7-14. [DOI: 10.1016/j.jocn.2019.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/04/2019] [Indexed: 11/20/2022]
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25
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Broad EM, Newsome LJ, Dew DA, Barfield J. Measured and predicted resting energy expenditure in wheelchair rugby athletes. J Spinal Cord Med 2019; 43:388-397. [PMID: 31017540 PMCID: PMC7241465 DOI: 10.1080/10790268.2019.1608062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: Report measured resting energy expenditure (REE) in wheelchair rugby athletes and evaluate agreement between REE and the prediction models of Chun, Cunningham, Harris-Benedict, Mifflin, Nightingale and Gorgey, and Owen.Design: Cohort-based validation study.Setting. Paralympic team training camp.Participants: Fourteen internationally competitive athletes who play wheelchair rugby, 13 of whom had cervical spinal cord injuries (SCI).Outcome Measures: A portable metabolic analyzer was used to measure REE following an overnight fast and dual-energy X-ray absorptiometry (DXA) was used to assess lean body mass for the prediction equations.Results: REE in the current sample was 1735 ± 257 kcal × day-1 ranging from 1324 to 2068 kcal × day-1. Bland-Altman analyses revealed negative mean bias but similar limits of agreement between measured REE and scores predicted by Chun, Cunningham, Mifflin, Nightingale and Gorgey, and Owen models in elite athletes who play wheelchair rugby.Conclusion: Prediction models regressed on persons with and without SCI under-predicted REE of competitive wheelchair rugby athletes. This outcome may be explained by the higher REE/fat-free mass (FFM) ratio of current athletes compared to less active samples. Findings from the current study will help practitioners to determine nutrient intake needs on training days of varied intensity.
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Affiliation(s)
| | - Laura J. Newsome
- Department of Health and Human Performance, Radford University, Radford, Virginia, USA
| | - Dustin A. Dew
- Lakeshore Foundation, Birmingham, Alabama, USA,UAB/Lakeshore Research Collaborative; School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J.P. Barfield
- Department of Athletic Training, Emory & Henry College, Emory, Virginia, USA,Correspondence to: J.P. Barfield, Exercise Science, Emory & Henry College, Box 947, Emory, VA 24327, USA.
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Comparison of estimated energy requirements using predictive equations with total energy expenditure measured by the doubly labelled water method in acute spinal cord injury. Spinal Cord 2019; 57:562-570. [DOI: 10.1038/s41393-019-0253-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/01/2018] [Accepted: 01/18/2019] [Indexed: 11/08/2022]
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Silveira SL, Winter LL, Clark R, Ledoux T, Robinson-Whelen S. Baseline Dietary Intake of Individuals with Spinal Cord Injury Who Are Overweight or Obese. J Acad Nutr Diet 2018; 119:301-309. [PMID: 30393077 DOI: 10.1016/j.jand.2018.08.153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) experience significant secondary health conditions including excess adiposity. Dietary guidelines for individuals with chronic SCI do not exist. OBJECTIVE To describe baseline dietary intake and quality based on conformance with dietary recommendations in participants enrolled in GoHealthySCI, a weight loss intervention for individuals with SCI, which promotes lifestyle change. DESIGN Cross-sectional analyses were conducted on data collected from April through August 2017 in a randomized pilot study. PARTICIPANTS Thirty-seven participants enrolled in the study in Houston, TX. All participants were at least 1 year post injury with a self-reported body mass index (calculated as kg/m2) ≥23. The racially/ethnically diverse sample was predominantly male (n=23), average age was 41.8±13.5 years, and average number of years since injury was 18.1±14.9. Participants varied in terms of level of injury; 19 participants identified as having tetraplegia and 19 identified as having paraplegia. MAIN OUTCOME MEASURES The Automated Self-Administered 24-Hour Recall dietary assessment was used to obtain baseline dietary intake data. Participants reported food intake on 3 nonconsecutive days. STATISTICAL ANALYSIS Descriptive statistics were conducted for the primary research objectives. Mean macronutrient and micronutrient intake and Healthy Eating Index-2015 total and component scores are described. RESULTS Average daily energy intake was 1618±434 kcal. Daily intakes of whole fruits (0.6±0.7 cups), vegetables (1.6±0.9 cups), and whole grains (15%) of total grains were lower than recommendations from the 2015-2020 Dietary Guidelines for Americans. Average daily fiber (15.0g±6.0) met the Academy of Nutrition and Dietetics Evidence Analysis Library minimum target range for individuals with SCI. All percentages of calories from macronutrients were within the acceptable macronutrient distribution ranges: total fat (34.3%±6.2%), protein (16.7%±4.2%), and carbohydrate (49.3%±8.4%). Mean Healthy Eating Index-2015 score was 54.4. CONCLUSIONS This study provides a description of dietary intake by individuals with SCI who are overweight or obese. Although macronutrients are within the acceptable distribution range, calories from fat are at the high end and those from protein are at the low end of those ranges. In addition, on average, individuals reported inadequate intake of fruits, vegetables, whole grains, fiber, seafood and plant protein, and healthy fats and excess intake of added sugars and saturated fat. Results provide preliminary evidence of dietary inadequacies and suggest that larger studies examining dietary intake are warranted.
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