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

Physiological Reports, 2024 · DOI: 10.14814/phy2.16099 · Published: May 20, 2024

Spinal Cord Injury Endocrinology Nutrition & Dietetics

Simple Explanation

Following spinal cord injury (SCI), numerous changes in body composition and metabolism occur due to skeletal muscle paralysis below the level of injury, increased fat mass (FM), and reductions in fat-free mass (FFM). Reductions in metabolically active lean tissue and impaired sympathetic nervous system activity also results in a decrease in basal metabolic rate (BMR). The BMR prediction equations serve as a surrogate for metabolic rate measurement and allow clinicians/dieticians to estimate energy needs for individuals with SCI.

Study Duration

October 2015 – March 2023

Participants

26 individuals with chronic SCI (12 innervated males, 6 innervated females, 8 denervated males)

Evidence Level

Cross-sectional study

Key Findings

1
SCI-specific equations by Chun et al., Nightingale & Gorgey, and AB-specific FFM equations accurately predicted BMR for innervated males.
2
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.
3
The Model 4 equation by Nightingale & Gorgey accurately estimated BMR in females with SCI.

Research Summary

This study validated existing BMR prediction equations in individuals with SCI, focusing on innervated and denervated subgroups, and examined differences between predicted and measured BMR in females and males with SCI. SCI-specific equations and AB-specific FFM prediction equations accurately predicted BMR for innervated males, while Model 4 equation by Nightingale and Gorgey was accurate in predicting BMR in innervated females with SCI. Common AB energy prediction equations including Schofield et al., Henry, Mifflin et al., and Harris & Benedict do not accurately estimate caloric needs within the innervated and denervated SCI population.

Practical Implications

Accurate Caloric Assessment

Using appropriate SCI-specific equations helps in accurately assessing caloric needs for individuals with spinal cord injuries.

Personalized Dietary Plans

The study underscores the significance of customizing separate dietary plans based on differences in sex after SCI to address metabolic requirements and caloric intake.

Improved Metabolic Health

Accurate BMR prediction aids in preventing overestimation or underestimation of energy expenditure, reducing the risk of obesity and secondary cardiometabolic complications.

Study Limitations

1
Small sample sizes for females and individuals with LMN injury.
2
Heterogeneity of impairment and completeness in the sample (paraplegic vs. tetraplegic).
3
Occurrences of spasticity or muscle spasms during BMR assessment may have influenced energy expenditure.

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