Spinal Cord Injury

SCI: Preventing Overweight (2007)

• Assessment
  How should body composition be measured in spinal cord injured people?

  • Conclusion

    Several methods exist to measure body composition in spinal cord-injured people, and all methods indicate that individuals with spinal cord injury have significantly higher fat mass and lower lean mass than able-bodied controls.  While dual-energy x-ray absorptiometry and bioelectric impedance analysis measures correlate with the reference standard total body water, different machine brands or machine settings can produce varied results.  In addition, the use of skinfold measurements and body mass index may be problematic because these methods were developed based on able-bodied persons. 

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: How should body composition be measured in spinal cord injured people?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Buchholz AC, McGillivray CF, Pencharz PB. The use of bioelectric impedance analysis to measure fluid compartments in subjects with chronic paraplegia.  Arch Phys Med Rehabil 2003;84:854-861. 
      • Desport JC, Preux PM, Guinvarc'h S, Rousset P, Salle JY, Daviet JC, Dudognon P, Munoz M, Ritz P.  Total body water and percentage fat mass measurements using bioelectrial impedance analysis and anthropometry in spinal cord-injury patients. Clinical Nutrition 2000;19(3):185-190.
      • Jones LM, Legge M, Goulding A. Healthy body mass index values often underestimate body fat in men with spinal cord injury. Arch Phys Med Rehabil 2003;84:1068-1071. 
      • Maggioni M, Bertoli S, Margonato V, Merati G, Veicsteinas A, Testolin G. Body composition assessment in spinal cord injury subjects. Acta Diabetol 2003;40:S183-S186.
      • Monroe MB, Tataranni PA, Pratley R, Manore MM, Skinner JS, Ravussin E. Lower Daily Energy Expenditure as Measured by a Respiratory Chamber in Subjects with Spinal Cord Injury Compared with Control Subjects. Am J Clin Nutr, 1998; 68: 1223-1227.
      • Olle MM, Pivarnik JM, Klish WJ, Morrow JR. Body Composition of Sedentary and Physically Active Spinal Cord Injured Individuals Estimated from Total Body Electrical Conductivity. Arch Phys Med Rehabil, 1993; 74: 706-710.
      • Spungen AM, Adkins RH, Stewart CA, Wang J, Pierson RN, Waters RL, Bauman WA. Factors influencing body composition in persons with spinal cord injury: a cross-sectional study. J Appl Physiol 2003; 95:2398-2407.
      • Spungen AM, Bauman WA, Wang J, Pierson Jr RN. Measurement of body fat in individuals with tetraplegia: a comparison of eight clinical methods. Paraplegia 1995;33:402-408.
  • Search Plan and Results: Overweight and Obesity 2006
     
  What are the indications for nutrition care to prevent or treat overweight and obesity in the community living phase of persons with Spinal Cord Injury?

  • Conclusion

    Due to decreased energy expenditure and caloric needs, secondary to lower levels of spontaneous physical activity and a lower thermic effect of food, adults in the chronic phase of spinal cord injury are frequently overweight or obese and therefore at risk of associated comorbidities such as diabetes and cardiovascular disease.  While methods of measuring body composition may be problematic in this population, body fat percentage is higher in individuals with spinal cord injury than able-bodied people.  Initial weight loss during the acute phase of spinal cord injury may lead to weight gain in the chronic phase due to body mass redistribution. 

     

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What are the indications for nutrition care to prevent or treat overweight and obesity in the chronic phase of SCI?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Chin DE, Kearns P. Nutrition in the Spinal-Injured Patient. NCP. 1991; 6(6):213-222. 
      • Claus-Walker J, Halstead LS. Metabolic and Endocrine Changes in Spinal Cord Injury: I. The Nervous System Before and After Transection of the Spinal Cord. Arch Phys Med Rehabil.  1981;62:595-601.
      • Cox SAR, Weiss SM, Posuniak EA, Worthington P, Prioleau M, Heffley G. Energy Expenditure after Spinal Cord Injury: Evaluation of Stable Rehabilitating Patients. J Trauma 1985; 25: 419-423.
      • Kocina P. Body Composition of Spinal Cord Injured Adults. Sports Med. 1997;23(1): 48-60.
      • Monroe MB, Tataranni PA, Pratley R, Manore MM, Skinner JS, Ravussin E. Lower Daily Energy Expenditure as Measured by a Respiratory Chamber in Subjects with Spinal Cord Injury Compared with Control Subjects. Am J Clin Nutr, 1998; 68: 1223-1227.
      • Olle MM, Pivarnik JM, Klish WJ, Morrow JR. Body Composition of Sedentary and Physically Active Spinal Cord Injured Individuals Estimated from Total Body Electrical Conductivity. Arch Phys Med Rehabil, 1993; 74: 706-710.
      • Peiffer SC, Blust P, Leyson JF. Nutritional Assessment of the Spinal Cord Injured Patient. J Am Diet Assoc, 1981; 78: 501-505.
      • Tharion G, Prasad KR, Gopalan L, Bhattacharji S. Glucose Intolerance and Dyslipidaemias in Persons with Paraplegia and Tetraplegia in South India. Spinal Cord, 1998; 36: 228-230.
  • Search Plan and Results: Overweight and Obesity 2006