Energy Expenditure and Nutrition in Neurogenic Obesity following Spinal Cord Injury

J Phys Med Rehabil, 2020 · DOI: · Published: March 27, 2020

Spinal Cord Injury Endocrinology Nutrition & Dietetics

Simple Explanation

Spinal cord injury (SCI) can lead to changes in body composition, including loss of muscle mass and bone mineral content, which decreases total daily energy expenditure and increases adipose tissue accumulation, a condition known as neurogenic obesity. Metabolic dysfunction after SCI includes impaired glucose tolerance, insulin resistance, and dyslipidemia, increasing the risk of diabetes and cardiovascular disease. Nutritional deficiencies following SCI result from obligatory sarcopenia, decreased physical activity, anabolic deficiency and sympathetic nervous system blunting, placing the energy needs of individuals following SCI significantly below that of an able-bodied individual.

Study Duration

Not specified

Participants

Veterans and individuals with spinal cord injury

Evidence Level

Systematic review and meta-analysis

Key Findings

1
Equations developed for able-bodied individuals inaccurately assess energy expenditure for those with SCI.
2
Individuals with SCI may not need the recommended dietary values provided by the USDA due to structural and functional changes following the injury.
3
SCI is associated with changes in body composition, metabolic syndrome and dysfunction, and overall homeostatic dysregulation, impacting nutritional health.

Research Summary

Spinal cord injury (SCI) leads to changes in body composition, specifically an obligatory sarcopenia, which contributes to a significant decrease in total daily energy expenditure (TDEE) and an accumulation of adipose tissue, referred to as neurogenic obesity. Metabolic dysfunction after SCI is marked by a greater occurrence of impaired glucose tolerance, insulin resistance, and dyslipidemia which leads to increased frequencies of diabetes mellitus and cardiovascular disease. Evidence-based guidelines for individuals with SCI are needed and should be rooted in clinical trials aimed at improving body composition, metabolic profiles, and nutritional health.

Practical Implications

Improved Energy Expenditure Assessment

The development of SCI-specific equations and correction factors for estimating BMR and TDEE can lead to more accurate caloric intake recommendations.

Personalized Nutritional Guidelines

Further research on dietary requirements relative to body composition is needed to develop personalized nutritional guidelines for individuals with SCI.

Targeted Interventions

Monitoring caloric intake based on BMR and TDEE can mitigate neurogenic obesity and metabolic syndrome while addressing nutritional deficiencies in the SCI population.

Study Limitations

1
Lack of evidence-based nutritional guidelines for individuals with chronic SCI.
2
Current equations to estimate BMR do not account for TEF and TEPA and are therefore unable to estimate TDEE.
3
The exact dietary requirements of individuals living with SCI warrants further research.

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