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Nevin AN, Atresh SS, Vivanti A, Ward LC, Hickman IJ. Resting energy expenditure during spinal cord injury rehabilitation and utility of fat-free mass-based energy prediction equations: a pilot study. Spinal Cord Ser Cases 2024; 10:70. [PMID: 39358343 PMCID: PMC11447238 DOI: 10.1038/s41394-024-00682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 09/17/2024] [Accepted: 09/20/2024] [Indexed: 10/04/2024] Open
Abstract
STUDY DESIGN Longitudinal observational study. Measurements were undertaken between weeks 4-6 post-spinal cord injury (SCI), repeated at week 8 and every 4 weeks thereafter until week 20 or rehabilitation discharge, whichever occurred first. OBJECTIVES Observe variation in measured resting energy expenditure (REE) and body composition in males undergoing SCI rehabilitation, compare REE with SCI-specific prediction equations incorporating fat-free mass (FFM), and explore the prevalence of clinical factors that may influence individual REE. SETTING Spinal Injuries Unit, Brisbane, Queensland, Australia. METHODS Indirect calorimetry was used to measure REE and bioimpedance spectroscopy to assess body composition. Four SCI-specific FFM-based REE and basal metabolic rate (BMR) prediction equations were compared to measured REE. A clinically significant change in REE was defined as +/- 10% difference from the week 4-6 measurement. Clinical factors that may affect REE variations were collected including infection, pressure injuries, autonomic dysreflexia, spasticity, and medications. RESULTS Fifteen people participated (mean age 35 ± 13 years, 67% paraplegic). There was no statistically significant change in mean REE, weight, or body composition, and the Chun and Nightingale BMR prediction equations performed best (rc > 0.8 at all time points). One-third of participants had >10% change in REE on 11 occasions, with clinical factors not consistently associated with the observed changes. CONCLUSION During SCI rehabilitation, mean REE, weight, and body composition remain unchanged, and FFM-based BMR prediction equations may be an acceptable alternative to indirect calorimetry. Future research designs should avoid single indirect calorimetry measures as snapshot data may not represent typical REE in this population.
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Affiliation(s)
- Amy N Nevin
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.
- The Hopkins Centre, School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Sridhar S Atresh
- The Hopkins Centre, School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Angela Vivanti
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- ULTRA Team, University of Queensland Clinical Trial Capability, Brisbane, QLD, Australia
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Alazzam AM, Gorgey AS. Validation of basal metabolic rate equations in persons with innervated and denervated chronic spinal cord injury. Physiol Rep 2024; 12:e16099. [PMID: 38872507 PMCID: PMC11176742 DOI: 10.14814/phy2.16099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/15/2024] Open
Abstract
Basal metabolic rate (BMR) measurement is time consuming and requires specialized equipment. Prediction equations allow clinicians and researchers to estimate BMR; however, their accuracy may vary across individuals with chronic spinal cord injury (SCI). The objective of this study was to investigate the validity of SCI-specific equations as well as able-bodied (AB) prediction equations in individuals with upper motor neuron (UMN), lower motor neuron (LMN), and females with SCI. Twenty-six men and women with chronic SCI (n = 12 innervated males, n = 6 innervated females, n = 8 denervated males) participated in this cross-sectional study. BMR values were measured by indirect calorimetry. Body composition (dual-energy X-ray absorptiometry and anthropometrics) assessment was conducted. AB-prediction equations [Cunningham, Nelson, Owen, Harris and Benedict, Mifflin, Schofield, Henry] and SCI-specific equations [Chun and Nightingale & Gorgey] were used to estimate and validate BMR. The accuracy of AB-specific FFM equations in predicting BMR was evaluated using Bland-Altman plots, paired t-tests, and error metrics. Measured BMR for innervated males, females, and denervated males was 1436 ± 213 kcal/day, 1290 ± 114, and 1597 ± 333 kcal/day, respectively. SCI-specific equations by Chun et al., Nightingale & Gorgey, and AB-specific FFM equations accurately predicted BMR for innervated males. 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. We demonstrated that SCI-specific equations accurately predicted BMR for innervated males but underpredicted it for denervated males. The Model 4 equation by Nightingale & Gorgey accurately estimated BMR in females with SCI. Findings from the current study will help to determine caloric needs in different sub-groups of SCI.
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Affiliation(s)
- Ahmad M Alazzam
- Spinal Cord Injury and Disorders Center, Richmond VA Medical Center, Richmond, Virginia, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Richmond VA Medical Center, Richmond, Virginia, USA
- Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Nevin AN, Urquhart S, Atresh SS, Geraghty TJ, Walter E, Ryan EG, Vivanti A, Ward LC, Hickman IJ. A longitudinal analysis of resting energy expenditure and body composition in people with spinal cord injury undergoing surgical repair of pressure injuries: a pilot study. Eur J Clin Nutr 2023; 77:386-392. [PMID: 36477671 DOI: 10.1038/s41430-022-01248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data informing energy needs of people with spinal cord injury (SCI) and pressure injuries are scarce, the impact of surgical repair unknown, and the role of body composition in healing unexplored. The study aims were to investigate resting energy expenditure (REE) over the course of pressure injury surgical repair, compare with available energy prediction equations, and explore associations between body composition and wound healing. METHODS Indirect calorimetry measured REE pre-surgery, post-surgery, at suture removal and hospital discharge. A clinically significant change was defined as +/-10% difference from pre-surgery. Eight SCI-specific energy prediction equations were compared to pre-surgery REE. Wound breakdown (Yes/No), weight, waist circumference (WC), and body composition (fat mass [FM], fat-free mass [FFM], bioimpedance spectroscopy) were measured. RESULTS Twenty people underwent pressure injury surgical repair (95% male, mean age 56 ± 12 years, 70% paraplegia). Between pre-surgery and discharge, mean REE increased (+118 kcal/d, p = 0.005), but with <10% change at any timepoint. An energy prediction equation incorporating FFM showed greatest agreement (rc = 0.779, 95% CI: 0.437, 0.924). Those with wound breakdown (65%) had a higher weight (12.7 kg, 95% CI: -4.0, 29.3), WC (17.8 cm, 95% CI: -5.1, 40.7), and FM % (36.0% [IQR 31.8, 40.2] vs 26.0% [IQR 15.6, 41.3]) than those without wound breakdown, although statistical significance was not reached. CONCLUSION The presence of pressure injuries and subsequent surgical repair did not impact REE and energy prediction equations incorporating FFM performed best. While not statistically significant, clinically important differences in body composition were observed in those with wound breakdown.
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Affiliation(s)
- Amy N Nevin
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia. .,The Hopkins Centre - Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Brisbane, QLD, Australia. .,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Susan Urquhart
- Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Sridhar S Atresh
- The Hopkins Centre - Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Timothy J Geraghty
- The Hopkins Centre - Research for Rehabilitation and Resilience, Metro South Health and Griffith University, Brisbane, QLD, Australia.,Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Elizabeth Walter
- Spinal Injuries Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Elizabeth G Ryan
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Angela Vivanti
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Recent Updates in Nutrition After Spinal Cord Injury: 2015 Through 2021. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clinical Evaluation Of The New Indirect Calorimeter In Canopy And Face Mask Mode For Energy Expenditure Measurement In Spontaneously Breathing Patients. Clin Nutr 2022; 41:1591-1599. [DOI: 10.1016/j.clnu.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 11/20/2022]
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O'Brien LC, Graham ZA, Chen Q, Lesnefsky EJ, Cardozo C, Gorgey AS. Plasma adiponectin levels are correlated with body composition, metabolic profiles, and mitochondrial markers in individuals with chronic spinal cord injury. Spinal Cord 2018; 56:863-872. [PMID: 29559683 PMCID: PMC6129201 DOI: 10.1038/s41393-018-0089-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 12/15/2022]
Abstract
STUDY DESIGN Cross-sectional design. OBJECTIVES This study examined the relationships between circulating adiponectin levels, body composition, metabolic profile, and measures of skeletal muscle mitochondrial enzyme activity and biogenesis. SETTINGS Clinical Research in a Medical Center. METHODS Plasma adiponectin was quantified in 19 individuals with chronic spinal cord injury (SCI). Body composition was evaluated by dual x-ray absorptiometry and magnetic resonance imaging. Metabolic profile was assessed by basal metabolic rate (BMR), oxygen uptake (VO2), and intravenous glucose tolerance testing. Mitochondrial enzyme activity of skeletal muscle was obtained by spectrophotometric assays and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) and 5' AMP-activated protein kinase (AMPK) protein expression was assessed by Western blots. RESULTS Adiponectin was negatively related to both total and regional fat mass and positively related to lean mass and muscle mass. Furthermore, there were positive relationships between adiponectin and BMR (r = 0.52, P = 0.02) and VO2 (r = 0.73, P = 0.01). Furthermore, adiponectin was positively related to citrate synthase (r = 0.68, P = 0.002) and complex III activity (r = 0.57, P = 0.02). The relationships between adiponectin and body composition remained significant after accounting for age. The relationships between adiponectin, metabolic profile, and markers of mitochondria mass and activity were influenced by age. CONCLUSIONS The study demonstrated that adiponectin is closely related to body composition and metabolic profile in persons with SCI and further supports mechanistic studies suggesting that adiponectin may stimulate mitochondrial biogenesis.
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Affiliation(s)
- Laura C O'Brien
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA, USA
| | - Zachary A Graham
- Department of James J. Peters VA Medical Center, Bronx, NY, USA.,Department of Medicine, Icahn School of Medicine, New York, NY, USA
| | - Qun Chen
- Department of Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Edward J Lesnefsky
- Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA, USA.,Department of Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.,Medical Services, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christopher Cardozo
- Department of James J. Peters VA Medical Center, Bronx, NY, USA.,Department of Medicine, Icahn School of Medicine, New York, NY, USA.,Department of Rehabilitation Medicine, Icahn School of Medicine, New York, NY, USA.,Department of Pharmacologic Science, Icahn School of Medicine, New York, NY, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA. .,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA.
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Nevin AN, Nguyen K, Atresh S, Vivanti A, Hickman IJ. Effective management of spasticity and impacts on weight change and resting energy expenditure in a female with spinal cord injury: a case report. Spinal Cord Ser Cases 2017; 3:17057. [PMID: 28919982 DOI: 10.1038/scsandc.2017.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/26/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The impact of muscle spasticity on weight change and energy expenditure after spinal cord injury (SCI) is not well understood. CASE PRESENTATION This case study reports changes to body weight and resting energy expenditure (REE) in a 36-year-old female (T3 AIS A SCI; 80 kg; body mass index=28 kg m-2 at injury) requiring escalating therapies to manage severe spasticity. Body weight, spasticity medications and fasted REE (measured using indirect calorimetry, canopy hood) were recorded at 4, 16, 17, 20 and 44 months post injury. Spasticity was assessed at each time point using the Modified Ashworth Scale (MAS). At 4 months post injury, REE was high (1710 kcal per day) corresponding with severe spasticity in the lower limbs (4 on the MAS). Over the following 12 months, the patient experienced an 8 kg weight loss, visible lower limb muscle wasting and a 30% reduction in REE while requiring increasing drug therapies for spasticity. With insertion of an intrathecal Baclofen pump at 17 months and cessation of other medications, spasticity improved markedly and weight increased by 6 kg in 27 months without any significant change to REE (mean=1260 kcal±2%). DISCUSSION Effective management of spasticity with intrathecal Baclofen appears to be associated with weight gain but not REE. Without body composition and activity energy expenditure data, this observation is difficult to explain. Regardless, routine weight monitoring with appropriate dietary counselling should be considered in this patient group to help prevent unintentional weight gain.
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Affiliation(s)
- Amy N Nevin
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland, Australia
| | - Khanh Nguyen
- Spinal Injuries Unit, Princess Alexandra Hospital, Queensland, Australia
| | - Sridhar Atresh
- Spinal Injuries Unit, Princess Alexandra Hospital, Queensland, Australia
| | - Angela Vivanti
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland, Australia.,School Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland, Australia.,Mater Research Institute, University of Queensland, Translational Research Institute, Queensland, Australia
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