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Recommendations Summary

SCI: Nutrition Assessment of Body Composition 2009

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    SCI: Assessment of Body Composition: Estimation of Ideal Body Weight

    The registered dietitian should estimate ideal body weight for persons with spinal cord injury by adjusting the Metropolitan Life Insurance tables for individuals of equivalent height and weight. There are two reported methods for adjusting the tables:

    • Quadraplegia, reduction of 10% to 15% lower than table weight; paraplegia, reduction of 5% to 10% lower than table weight
    • Quadriplegia, 15 lbs to 20 lbs lower than table weight; paraplegia, 10 lbs to 15 lbs lower than table weight.

    Rating: Consensus
    Imperative

    SCI: Assessment of Body Composition: BMI and skinfold measurements

    The registered dietitian should not use body mass index (BMI) or skinfold measurements to measure body composition in persons with spinal cord injury. These methods may not provide reliable results since they were developed based on able-bodied persons.

    Rating: Fair
    Imperative

    SCI: Assessment of Body Composition: BIA and DEXA

    For persons with spinal cord injury who are medically stable, the registered dietitian should consider using bioelectric impedance analysis (BIA) or dual-energy X-ray absorptiometry (DEXA) to assess body composition. Evidence suggests that BIA and DEXA correlate with measures of total body water (TBW) when labeled water is used to provide a reference value for TBW. Persons with spinal cord injury have significantly higher fat mass and lower lean mass than persons without spinal cord injury.

    Rating: Fair
    Conditional

    • Risks/Harms of Implementing This Recommendation

      DEXA screening requires exposure to radiation.

    • Conditions of Application

      • DEXA scanning may be inappropriate for some persons with spinal cord injury due to spasms, contracture or tall stature
        • DEXA scanning requires the subject to lie flat and still on the scanning table
        • If the subject is taller than the scanning table, the full body will not be scanned
        • DEXA scanning requires exposure to radiation, although the exposure is low
        • Cost and availability issues may preclude some persons with spinal cord injury from obtaining DEXA screening.
      • Weight of external fixation devices such as halos and orthotics should be considered when determining body weight
      • Aim for consistency in method and equipment used in measuring weight.

    • Potential Costs Associated with Application

      • Organizational costs are associated with the provision and maintenance of equipment required for the measurement of body composition using DEXA or BIA
      • Organizational costs are associated with the provision of staff required to assess the body composition of persons with spinal cord injuries.

    • Recommendation Narrative

      SCI: Assessment of Body Composition: Estimation of Ideal Body Weight

      A neutral-quality case-series study recommended that ideal body weights for persons with spinal cord injuries be below those recommended by the NY Metropolitan Life Insurance table: Individuals with paraplegia, 10 lbs to 15 lbs lower; with quadriplegia, 15 lbs to 20 lbs lower (Peiffer et al, 1981).

      SCI: Assessment of Body Composition: BMI and Skinfold Measurements

      • One neutral-quality case-control study found that, although BMI was not significantly different between subjects with SCI and able-bodied controls, when body composition was assessed using DEXA, SCI subjects had significantly greater fat mass and significantly less lean mass than controls (Jones et al, 2003)
      • One neutral-quality case-control study found that, although fat mass did not differ significantly between subjects with SCI and able-bodied controls when measured by skinfold, when body composition was assessed using DEXA, SCI subjects had significantly greater fat mass than controls (Maggioni et al, 2003).

      SCI: Assessment of Body Composition: BIA and DEXA

      • One positive-quality case-control study found that able-bodied control subjects had significantly greater lean body mass than SCI subjects (Monroe et al, 1998)
      • One neutral-quality case-control study found that, using DEXA,  total body and regional lean mass were significantly less and fat mass was significantly greater in subjects with SCI than able-bodied controls (Spungen et al, 2003)
      • One neutral-quality case-control study using labeled water as a reference standard found that TBW and therefore fat-free mass and fat mass, can be reasonably well-predicted in patients with SCI using BIA and two equations (Buchholz et al, 2003)
      • One neutral-quality cross-sectional study found that BIA using 100kHz energy correlated acceptably with labeled water in predicting TBW in patients with spinal cord injuries (Desport et al, 2000)
      • One neutral-quality cross-sectional study found that fat percentage as measured by total body electrical conductivity (TBEC) correlated significantly with fat percentage as estimated by summing seven skinfold measurements (Olle et al, 1993)
      • One neutral-quality cross-sectional study found no significant differences among BIA, DEXA, TBW and the Steinkamp methods when measuring total body fat in spinal cord-injured persons (Spungen et al, 1995).

    • Recommendation Strength Rationale

      • Results are consistent across eight studies with minor exceptions at most
      • Conclusion statement is Grade II.

    • Minority Opinions

      Consensus reached.