SCI: Preventing Overweight (2007)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To provide an overview of:

  1. prevalence of diseases associated with physical inactivity and obesity in SCI population,
  2. alterations in body composition following SCI,
  3. recommendations for assessing body composition of SCI individuals in clinical settings
Inclusion Criteria:
  • None given.
Exclusion Criteria:
  • None given.
Description of Study Protocol:


Methods of study inclusion not specified.


Narrative Review.

Blinding Used (if applicable):

Not applicable.

Intervention (if applicable):

Not applicable.

Statistical Analysis: 

Statistical analysis not performed.

Data Collection Summary:

Timing of Measurements

Not applicable.

Dependent Variables

Not applicable.

Independent Variables

Not applicable.

Control Variables

Description of Actual Data Sample:

Initial N:  87 references cited.

Attrition (Final N):  87

Age:  not mentioned

Ethnicity:  not mentioned

Other relevant demographics:


Location:  Worldwide studies

Summary of Results:

Disease Risk Factors higher in SCI

  • Obesity
  • Cardiovascular disease (lipid abnormality)
  • Type 2 diabetes (glucose intolerance)
  • Osteoporosis.

Fat-free composition changes following SCI

  • Mineral (bone mineral content decreases 25-50% depending on level, completeness and direction of SCI)
  • Protein (total body protein is reduced by 30%
  • Water (total body water relative to body weight decreases by 15%) 

Body Composition Assessment Techniques

  • Hydrostatic weighting
  • Dual-energy X-ray Absorptiometry
  • Skinfold methods
  • Bioelectrical impedance.
Author Conclusion:
  • Obesity is a major risk factor for developing cardiovascular disease, hypertension, diabetes mellitus, obstructive pulmonary disease, hypercholesterolemia, osteoarthritis, renal disease, and certain cancers. NIH defines obesity as bodyweight exceeding 20% of the desirable for a given age, sex, skeletal frame (this definition does not take into account relative amounts of fat and fat-free mass). A more useful definition is an excessive amount of total body fat for a given bodyweight. Ideal = 15% for adult men and 23% for adult women. Obesity >25% for men and >32% for women.
  • Cited studies found that fatness is related to level of spinal cord injury; that paraplegic athletics had lower fat mass;, and that sedentary SCI men had > 25% fat mass and physically active SCI men had 16-24% compared to 15% for able bodied males. Effect of physical activity on body fat in women is not well documented.
  • Body fat needs to be routinely evaluated as a part of the health profile of SCI individuals.
  • Methods for body composition assessment in SCI are problematic.
Funding Source:
University/Hospital: University of New Mexico
Reviewer Comments:
  • Comprehensive coverage of topic.
  • Done in “traditional” review style without mention of method for search, selection, or critique of sources.
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? ???
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? ???
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? ???
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? ???
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? ???
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? N/A
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? ???
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? No
  10. Was bias due to the review's funding or sponsorship unlikely? Yes