Validation of basal metabolic rate equations in persons with innervated and denervated chronic spinal cord injury

Abstract

Basal metabolic rate (BMR) measurement is time consuming and requires specialized equipment. Prediction equations allow clinicians and researchers to estimate BMR; however, their accuracy may vary across individuals with chronic spinal cord injury (SCI). The objective of this study was to investigate the validity of SCI‐specific equations as well as able‐bodied (AB) prediction equations in individuals with upper motor neuron (UMN), lower motor neuron (LMN), and females with SCI. Twenty‐six men and women with chronic SCI (n = 12 innervated males, n = 6 innervated females, n = 8 denervated males) participated in this cross‐sectional study. BMR values were measured by indirect calorimetry. Body composition (dual‐energy X‐ray absorptiometry and anthropometrics) assessment was conducted. AB‐prediction equations [Cunningham, Nelson, Owen, Harris and Benedict, Mifflin, Schofield, Henry] and SCI‐specific equations [Chun and Nightingale & Gorgey] were used to estimate and validate BMR. The accuracy of AB‐specific FFM equations in predicting BMR was evaluated using Bland–Altman plots, paired t‐tests, and error metrics. Measured BMR for innervated males, females, and denervated males was 1436 ± 213 kcal/day, 1290 ± 114, and 1597 ± 333 kcal/day, respectively. SCI‐specific equations by Chun et al., Nightingale & Gorgey, and AB‐specific FFM equations accurately predicted BMR for innervated males. For the denervated males, Model 4 equation by Nightingale & Gorgey was not different (p = 0.18), and Bland–Altman analyses showed negative mean bias but similar limits of agreement between measured and predicted BMR for the SCI‐specific equations and AB‐specific FFM equations. We demonstrated that SCI‐specific equations accurately predicted BMR for innervated males but underpredicted it for denervated males. The Model 4 equation by Nightingale & Gorgey accurately estimated BMR in females with SCI. Findings from the current study will help to determine caloric needs in different sub‐groups of SCI.