Caloric Intake Relative to Total Daily Energy Expenditure Using a Spinal Cord Injury–Specific Correction Factor

Abstract

Objective The aims of the study were to evaluate the influence of level of spinal cord injury (SCI) on caloric intake relative to total daily energy expenditure (TDEE) and body composition, and to develop a SCI–specific correction factor for the TDEE estimation. Design Individuals with paraplegia (PARA, n = 28) and tetraplegia (TETRA, n = 13) were analyzed. Daily caloric intake, basal metabolic rate, and TDEE were obtained using dietary recall, indirect calorimetry, and prediction equations, respectively. Caloric intake and TDEE were adjusted to bodyweight. Body composition was assessed using dual-energy x-ray absorptiometry. Results Total caloric (PARA 1516.4 ± 548.4, TETRA 1619.1 ± 564.3 kcal/d), fat (PARA 58.6 ± 27.4, TETRA 65.8 ± 29.7 g), and protein (PARA 62.7 ± 23.2, TETRA 71.5 ± 30.9 g) intake were significantly higher in TETRA versus PARA (P < 0.05) when adjusted for bodyweight. Adjusted and unadjusted TDEE (unadjusted: PARA 1851.0 ± 405.3, TETRA 1530.4 ± 640.4 kcal/d) and basal metabolic rate (unadjusted: PARA 1516.6 ± 398.0, TETRA 1223.6 ± 390.2 kcal/d) were significantly higher in PARA versus TETRA (P < 0.05). Bone mineral content (PARA 3.17 ± 0.6, TETRA 2.71 ± 0.5 g), lean body mass (PARA 50.0 ± 8.6, TETRA 40.96 ± 8.8 kg), and regional percent body fat (PARA 36.45 ± 8.0, TETRA 41.82 ± 9.1) were different between groups (P < 0.05). The SCI–specific correction factor was 1.15. Conclusions A dichotomy exists in caloric intake, TDEE, and body composition among TETRA and PARA. The SCI–specific correction factor of 1.15 is a promising tool to estimate TDEE in SCI. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Understand the influence of spinal cord level of injury on energy expenditure and body composition; (2) Appreciate that equations used to estimate total daily energy expenditure overestimate energy expenditure in individuals with spinal cord injury; and (3) Understand the importance of normalizing caloric intake to bodyweight after spinal cord injury. 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.

Body Composition According to Spinal Cord Injury Level: A Systematic Review and Meta-Analysis

“…We assessed 331 full texts, of which we identified 57 studies reporting on body composition according to the level of injury. Forty studies (40/57, 70.2%) [10,[13][14][15][16] could be quantitatively pooled (38 cross-sectional and 2 longitudinal analysis), which comprised 4872 individuals with SCI (Figure 1). Table 1 summarizes the study characteristics of quantitatively pooled studies, and the details of each study included in the systematic review can be found in Table S1.…”

“…Seventeen studies (17/57, 29.8) [10,12,17,18,42,[66][67][68][69][70][71][72][73][74][75] were excluded from the analysis but were qualitatively reported (Table S2). The reasons for exclusion were: (i) seven studies failed to provide quantitative measure among different injury levels, (ii) seven studies were deemed to be similar reports of an included study, (iii) two studies cannot be pooled due to difference in reporting, and (iv) one study did not provide measures of spread (no standard deviation).…”

“…Whole-body composition was estimated through various methods. Three studies used bioelectrical impedance [35,43,76], seven studies used X-ray absorptiometry [10,13,15,16,36,48,64], and one study used magnetic resonance imaging [14]. Individuals with tetraplegia had a higher mean fat percentage and lower mean lean mass compared to individuals with paraplegia with WMD 1.9%, (95% CI 0.6, 3.1; I 2 46.7%), and WMD −3.0 kg (95% CI −5.9, −0.2; I 2 84.1%), respectively (Table 2).…”

“…The accumulation of fat leads to impaired glucose metabolism [7] and dyslipidemia [8]. Additionally, individuals with chronic injury have a sedentary lifestyle and poor compliance with dietary recommendations [9,10]. Altogether, this creates a positive energy balance that is a major determinant for fat accumulation and obesity in chronic SCI [9].…”

Spinal Cord Injury Reduces Serum Levels of Fibroblast Growth Factor-21 and Impairs Its Signaling Pathways in Liver and Adipose Tissue in Mice

“…Persons with SCI have been reported to have reduced energy expenditure resulting from a marked reduction in lean tissue mass and in the ability to ambulate and/or exercise ( 39 , 40 ). On the other hand, recent reports indicated increased total food intake in persons with SCI when compared to individuals who were immobilized for reasons other than SCI ( 41 , 42 ).…”