Contributors to Metabolic Disease Risk Following Spinal Cord Injury

Curr Phys Med Rehabil Rep., 2016 · DOI: 10.1007/s40141-016-0124-7 · Published: September 1, 2016

Simple Explanation

Spinal cord injuries can disrupt metabolism, increasing the risk of diseases like type 2 diabetes and cardiovascular issues. The higher the injury on the spine, the greater the risk. Changes in body composition, such as increased fat and decreased muscle, don't fully explain the elevated disease risk. Reduced physical activity and changes in muscle fiber type also play a role. Brown adipose tissue (BAT) may be important for energy balance. Dysfunction of BAT may contribute to metabolic problems after spinal cord injury due to alterations in the autonomic nervous system.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
High-level spinal cord injuries are associated with lower glucose tolerance, greater insulin resistance, and impaired lipid profiles compared to lower-level injuries.
2
Skeletal muscles below the level of injury rapidly atrophy and transform into highly fatigable and glycolytic muscle fibers with impaired oxidative capacity.
3
Individuals with high-level SCI (tetraplegia) will have decreased BAT amount and function, relative to the impairment of SNS input.

Research Summary

Spinal cord injury (SCI) induced changes in neurological function have significant impact on the metabolism and subsequent metabolic-related disease risk in injured individuals. Although alterations in body composition, particularly excess adiposity and its anatomical distribution in the visceral depot or ectopic location in non-adipose organs, is known to significantly contribute to metabolic disease risk, changes in fat mass and fat-free mass do not fully account for this elevated disease risk in subjects with SCI. With the rediscovery of BAT in adult humans, a renewed interest in BAT as a mediator of SNS metabolic activity and metabolic-related disease risk has occurred.

Practical Implications

Personalized Interventions

Target interventions based on the level and severity of SCI to address specific metabolic risks.

BAT-Targeted Therapies

Explore therapies that stimulate or restore brown adipose tissue function to improve metabolic health in SCI patients.

Revised BMI Cutoffs

Re-evaluate and potentially revise BMI categories for individuals with SCI to accurately assess obesity and associated risks.

Study Limitations

1
Limited data on fat mass and adipose tissue distribution following spinal cord injury, particularly across sex, anatomical level, severity of injury, and time since injury.
2
Inconsistent findings regarding diet-induced thermogenesis and cold-induced thermogenesis in subjects with SCI due to varying study methodologies.
3
Significant physiological differences between rodent research models and humans stress the importance of additional research focused on the contribution of BAT in SCI population.

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