Energy Expenditure Following Spinal Cord Injury: A Delicate Balance

Top Spinal Cord Inj Rehabil, 2021 · DOI: 10.46292/sci20-00030 · Published: January 1, 2021

Spinal Cord Injury Physiology Rehabilitation

Simple Explanation

Following a spinal cord injury (SCI), changes in body composition and physical impairment can lead to weight gain if calorie intake exceeds energy expenditure. The reduction in lean body mass and other physiological changes after SCI disrupt energy balance and create an environment that promotes cardiometabolic dysfunction. Metabolic rate, which is the energy needed to support life, is significantly decreased after SCI. This decrease, coupled with SCI-related inactivity, can lead to the development of neurogenic obesity and associated health risks. Indirect calorimetry (IC) is a method to accurately measure metabolic rate and prevent over- or under-feeding. Because accurately predicting energy expenditure after SCI is difficult, IC can help optimize caloric needs during recovery and treatment.

Study Duration

Not specified

Participants

Persons with spinal cord injury and able-bodied individuals

Evidence Level

Review of literature

Key Findings

1
Measured metabolic rate is lower in persons with SCI compared to the nondisabled population, ranging from 1256 to 1854 kcal/day for individuals with longstanding SCI.
2
Prediction equations developed for nondisabled individuals overestimate metabolic rate in individuals with SCI by 4% to 92%.
3
An SCI-specific correction factor of 1.15 can be used to estimate total daily energy expenditure (TDEE) more accurately, potentially reducing the risk of obesity and cardiometabolic comorbidities.

Research Summary

Individuals with SCI are at risk for neurogenic obesity due to changes in body composition, reduced physical activity, and metabolic dysfunction. Accurate assessment of metabolic rate is crucial to prevent excess caloric intake and mitigate obesity-related comorbidities. Indirect calorimetry (IC) is the gold standard for measuring metabolic rate in individuals with SCI, as it provides an individualized measurement that accounts for specific injury characteristics. Prediction equations developed for nondisabled individuals are often inaccurate in the SCI population. By measuring metabolic rate and recommending healthy eating habits and physical activity, the high rates of morbidity and mortality caused by obesity and obesity-induced cardiometabolic dysfunction in persons with SCI can be mitigated.

Practical Implications

Clinical Practice

Implement indirect calorimetry as standard clinical practice to accurately determine metabolic rate and caloric needs for individuals with SCI.

Nutritional Support

Develop carefully designed nutrition support regimens based on individual metabolic needs to prevent malnutrition and optimize energy prescription after SCI.

Future Research

Further investigate the complex interactions within the energy balance system after SCI to develop more effective preventative strategies and treatments for obesity and cardiometabolic risks.

Study Limitations

1
Variations in metabolic rates reported in the literature
2
SCI-specific equations do not account for differences in neurological parameters and individual variation
3
Dietary recall questionnaires' accuracy for caloric intake assessment

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