Glucose intolerance and dyslipidaemias in persons with paraplegia and tetraplegia in South India

Tharion, George; Prasad, Kondapalli Siva; Gopalan, Lakshmi; Bhattacharji, Sara

doi:10.1038/sj.sc.3100566

Cited by 16 publications

(14 citation statements)

References 9 publications

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“…26 Patients with SCI have also been shown to have increased prevalence of impaired glucose tolerance, insulin resistance and diabetes, owing to the aforementioned adverse changes in body composition and, potentially, unknown causes. 4,[7][8][9] Other previously reported CHD risk factors after SCI include decreased physical activity, psychosocial factors of depression and social isolation, 27 elevated plasma homocysteine, 28 and increased levels of C-reactive protein. 29,30 In addition, evidence suggests that persons with chronic SCI have a circulating heavy-chain IgG that is the cause of loss of high-affinity prostacyclin receptors in platelets, which results in the absence of prostaglandin-induced inhibition of platelet-stimulated thrombin generation; furthermore, this IgG fragment is heterophilic, binding the platelet insulin receptor and blocking platelet nitric oxide synthesis.…”

Section: Discussionmentioning

confidence: 99%

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Measurement of coronary artery calcification by electron beam computerized tomography in persons with chronic spinal cord injury: evidence for increased atherosclerotic burden

Orakzai

Ahmadi

et al. 2007

Spinal Cord

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Background/Objective: Individuals with spinal cord injury (SCI) have been reported to have an increased prevalence of premature cardiovascular disease. Whether the increased risk of disease is owing to clustering of traditional cardiac risk factor or is over and above that predicted by risk factors was addressed. Methods: Ninety-one persons with chronic SCI were studied for subclinical atherosclerosis. Cardiac risk factors and coronary artery calcium (CAC) was compared to matched non-SCI controls. The 273 controls were 3:1 matched for age, gender, ethnicity and risk factors and were drawn from a national database of over 30 000 asymptomatic persons undergoing coronary scanning. Results: Seventy-six men and 15 women were studied. Average age was 49.7712 years. Duration of injury was 19.7710 years. The ethnicity of the study cohort included 36% Caucasian, 49% Latino, 10% African American, and 5% other. The mean calcium score of the SCI group was significantly greater than the control group (757218 versus 287104, Po0.001). The prevalence of any CAC score was greater in the SCI population than the control population (51 versus 39%, Po0.05), as was CAC score 4100 (16 versus 7%, Po0.01). Women with SCI had a significantly lower CAC score than men (mean score: 12 versus 86, Po0.01). Conclusion: Patients with SCI were shown to have greater atherosclerotic burden than ablebodied controls. Of note, and unexplained, this finding is beyond that explained by the clustering of traditional risk factors. On the basis of these findings, increased attention should be directed toward the prevention of coronary heart disease in those with SCI.

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Section: Discussionmentioning

confidence: 99%

“…4,[7][8][9] Additionally, these patients may not have symptoms despite significant CHD, partially owing to their reduced level of activity. 10 Thus, it is important to identify the presence of subclinical disease in these patients to initiate appropriate treatment for the primary prevention of CHD.…”

Section: Introductionmentioning

confidence: 99%

Measurement of coronary artery calcification by electron beam computerized tomography in persons with chronic spinal cord injury: evidence for increased atherosclerotic burden

Orakzai

Ahmadi

et al. 2007

Spinal Cord

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“…Impaired glucose tolerance, insulin resistance and diabetes occur more frequently in SCI versus able-bodied persons. 15,38,[41][42][43][44][45] Other potential CHD risk factors after SCI include decreased physical activity, psychosocial factors (depression, isolation), and elevated plasma homocysteine and C-reactive protein. 46 Increased fat mass has also been identified as an important risk factor in chronic SCI and weight management is recommended as a key CHD prevention strategy.…”

Section: Body Mass Index (Bmi) As a Marker Of Obesity In Chronic Scimentioning

confidence: 99%

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

2005

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Study design: Literature review. Background: Increased fat mass and coronary heart disease (CHD) are secondary complications of chronic spinal cord injury (SCI). In able-bodied populations, body mass index (BMI, body weight (kg)/height (m 2 )) is a widely used surrogate marker of obesity and predictor of CHD risk. Waist circumference, an accurate and reproducible surrogate measure of abdominal visceral adipose tissue, is also associated with CHD risk (more so than BMI) in able-bodied populations. Objective: To review the literature on the accuracy of BMI and waist circumference as surrogate measures of obesity and CHD risk in persons with chronic SCI. Setting: Ontario, Canada. Methods: Literature review. Results: In the SCI population, BMI is an insensitive marker of obesity, explains less of the variance in measured percent fat mass than in the able-bodied, and is inconsistently related to CHD risk factors. This may be due to potential measurement error, and to the inability of BMI to distinguish between fat and fat-free mass and to measure body fat distribution. Waist circumference has not been validated as a surrogate measure of visceral adipose tissue, however preliminary evidence supports a relationship between waist circumference and CHD risk in the SCI population. Conclusions: We recommend that SCI-specific BMI classifications be determined. We also recommend that accuracy and reliability of waist circumference as a surrogate measure of visceral adipose tissue and CHD risk be determined in men and women with long-standing paraplegia and tetraplegia. Body mass index (BMI) as a marker of obesity in chronic SCIObesity is defined as an excess accumulation of fat mass. Able-bodied men and women p40 years are considered obese when fat mass exceeds 22-25 and 35% of body weight, respectively. 1,2 As individuals age, fat mass accrues at the expense of fat-free mass, so that at older ages percentage fat mass is higher, even in individuals who do not gain weight. 3 Thus, obesity in 41-60-yearold able-bodied men and women can be defined as a fat mass 425 and 438% of body weight, respectively. 2 Mean percent fat mass (measured by dual energy X-ray absorptiometry (DXA), isotope dilution or the threecompartment model) reported in cross-sectional studies of persons (mostly men) with chronic spinal cord injury (SCI) ranges from 23 to 35%. [4][5][6][7][8][9][10][11] The percentage of body weight as fat mass is 8-18% higher in SCI versus age-, height-and/or weight-matched able-bodied control subjects. These values are often consistent with the above definitions of obesity, and are summarized in Table 1. Accurate classification of an individual as normal weight, overweight or obese requires measurement of body composition. However, measuring fat mass can be difficult and expensive, and no accurate method is easily available for routine clinical use. Therefore, the body mass index (BMI) is widely used. Expressed as weight (kg) divided by height (m 2 ), BMI allows classification of able-bodied adults as underweight, normal we...

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“…Impaired glucose tolerance and diabetes mellitus occur more frequently in persons with SCI than in the able‐bodied population 75,76,83–86 . Peripheral resistance of insulin to mediate glucose uptake may be demonstrated in most individuals with SCI having a disorder in glucose tolerance.…”

Section: Carbohydrate Metabolism In Persons With Scimentioning

confidence: 99%

The potential metabolic consequences of cerebral palsy: inferences from the general population and persons with spinal cord injury

Bauman

2009

Develop Med Child Neuro

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The metabolic consequences of cerebral palsy (CP) have not been reported. The observations and suggestions presented in this article are based on our current knowledge of physiology in the general population and on information on the known metabolic consequences of disability in persons with spinal cord injury. Because of pain, fatigue, and other secondary consequences of CP, adolescents with CP who are ambulatory may become less physically active with age. This phenomenon would be expected to be associated with deconditioning and adverse changes in body composition including atrophy of muscles and an absolute or relative increase in adiposity. Insulin resistance, hyperinsulinemia, and associated adverse metabolic changes may develop. In an unfavorable metabolic milieu, the ability of the pancreas to compensate for mild elevations of circulating glucose may diminish. The combination of reduced fitness and conventional risk factors for cardiovascular disease would be expected to increase the risk for coronary heart disease (CHD); however, there has been no assessment of the risk factors for CHD in adults with CP. Once subgroups with modifiable risk factors for cardiovascular disease have been identified, risk factors for CHD should be aggressively treated, according to current standards of care.

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Glucose intolerance and dyslipidaemias in persons with paraplegia and tetraplegia in South India

Cited by 16 publications

References 9 publications

Measurement of coronary artery calcification by electron beam computerized tomography in persons with chronic spinal cord injury: evidence for increased atherosclerotic burden

Measurement of coronary artery calcification by electron beam computerized tomography in persons with chronic spinal cord injury: evidence for increased atherosclerotic burden

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

The potential metabolic consequences of cerebral palsy: inferences from the general population and persons with spinal cord injury

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