Caloric intake relative to total daily energy expenditure using a spinal cord injury-specific correction factor: an analysis by level of injury

Am J Phys Med Rehabil, 2019 · DOI: 10.1097/PHM.0000000000001166 · Published: November 1, 2019

Spinal Cord Injury Physiology Rehabilitation

Simple Explanation

Spinal cord injury (SCI) can lead to changes in body composition and an increased risk for various health problems. These changes often include a decrease in total daily energy expenditure (TDEE) that is not matched by a reduction in caloric intake, leading to weight gain. This study aimed to examine how the level of SCI (paraplegia vs. tetraplegia) affects caloric intake, energy expenditure, and body composition. The researchers also sought to develop a specific correction factor to more accurately estimate TDEE in individuals with SCI. The study found that individuals with tetraplegia consumed more calories relative to their body weight compared to those with paraplegia. Additionally, those with paraplegia had higher energy expenditure, while those with tetraplegia had a greater percentage of body fat.

Study Duration

Three years

Participants

41 individuals with chronic motor complete SCI (28 paraplegia, 13 tetraplegia)

Evidence Level

Not specified

Key Findings

1
Individuals with tetraplegia had significantly higher total caloric, fat, and protein intake when adjusted for body weight compared to those with paraplegia.
2
Basal metabolic rate (BMR) and total daily energy expenditure (TDEE) were significantly greater in individuals with paraplegia compared to tetraplegia.
3
Individuals with paraplegia had significantly greater bone mineral content (BMC) and lean body mass (LBM), while those with tetraplegia showed a significantly greater amount of percent regional body fat.

Research Summary

This study investigated the influence of the level of spinal cord injury (SCI) on caloric intake relative to total daily energy expenditure (TDEE) and body composition (BC). It also aimed to develop a SCI-specific correction factor for TDEE estimation. The results showed that individuals with tetraplegia had a significantly greater total caloric, fat, and protein intake compared to those with paraplegia when nutrients were adjusted to bodyweight. BMR and TDEE were significantly greater in those with paraplegia compared to tetraplegia. The study concluded that level of injury influences macronutrients, energy expenditure, and body composition. The SCI-specific activity factor of 1.15 may help in estimating TDEE in individuals with SCI.

Practical Implications

Accurate TDEE Estimation

The SCI-specific correction factor of 1.15 offers a more accurate method to estimate TDEE in individuals with SCI, potentially improving dietary recommendations.

Targeted Interventions

Understanding the differences in caloric intake, energy expenditure, and body composition between paraplegia and tetraplegia can inform targeted interventions to manage weight and metabolic health.

Personalized Nutrition Plans

Healthcare professionals can use these findings to develop personalized nutrition plans that account for the specific needs of individuals with different levels of SCI, helping to prevent or manage neurogenic obesity.

Study Limitations

1
Dietary recall was self-reported, and participants may have underreported their true caloric intake.
2
The sample size of tetraplegia, as well as female participants, was relatively small compared to the paraplegia group.
3
The SCI-specific TDEE correction factor of 1.15 was not validated and its reliability was not shown.

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