Characteristics of abdominal obesity in persons with spinal cord injury

Outcomes in socioeconomically disadvantaged patients with spinal cord injury: a systematic review

OBJECTIVEIndividuals with a spinal cord injury (SCI) in socioeconomically disadvantaged settings (e.g., rural or low income) have different outcomes than their counterparts; however, a contemporary literature review identifying and measuring these outcomes has not been published. Here, the authors' aim was to perform a systematic review and identify these parameters in the hope of providing tangible targets for future clinical research efforts.METHODSA systematic review was performed to find English-language articles published from 2007 to 2017 in the PubMed/MEDLINE, EMBASE, and SCOPUS databases. Studies evaluating any outcomes related to patients with an SCI and in a low-resource setting were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a flowchart was created. Of the 403 articles found, 31 underwent complete review and 26 were eligible for study inclusion. According to the current study criteria, any case studies, studies in less developed countries, studies including and not separating other types of neurological disorders, studies not assessing the effects of a low-resource setting on outcomes in patients with SCI, and studies evaluating the causes of SCI in a low-resource setting were excluded.RESULTSIn SCI patients, a lower income was a predictor of death (OR 2.1, 95% CI 1.7-2.6, p = 0.0002). Moreover, secondary outcomes such as pain intensities (OR 3.32, 95% CI 2.21-4.49, p < 0.001), emergency room visits (11% more likely, p = 0.006), and pressure ulcer formation (OR 2.1, 95% CI 1.5-3.0, p < 0.001) were significantly higher in the lower income brackets. Rurality was also a factor and was significantly associated with increased emergency room visits (OR 1.5, 95% CI 1.1-2.1, p = 0.01) and lower outpatient service utilization (incidence rate ratio [IRR] 0.57, 95% CI 0.35-0.93, p < 0.05).CONCLUSIONSThe authors showed that individuals in a low-resource setting who have suffered an SCI have significantly different outcomes than their counterparts. These specific outcomes are promising targets for future research efforts that focus on improving health conditions among this population.

The effect of behavioral intervention and nutrition education program on serum lipid profile, body weight and blood pressure in Iranian individuals with spinal cord injury: A randomized clinical trial

OBJECTIVE

The efficacy of nutrition education on body weight and serum lipids has not yet been described in patients with spinal cord injury (SCI). In the present study, we examined the effect of a 7-month nutrition education program on lipid profile and body weight in individuals with SCI.

DESIGN

Randomized clinical trial.

SETTING

A tertiary rehabilitation center.

PARTICIPANTS

Patients with SCI who were referred to Brain and Spinal Cord Injury Research Center.

INTERVENTION

The nutrition education program consisted of 5 education sessions during a period of 7 months.

OUTCOME MEASURES

Body weight and serum concentrations of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measure at the beginning of the trial and after 7 months. Two-way repeated measure analysis of variance (ANOVA) was used.

RESULTS

Total of 57 patients (27 in control group and 30 in education group) participated. Nutrition education program showed no significant effect on the levels of TC, TG, LDL-C and HDL-C (P: 0.224, 0.172, 0.107 and 0.081, respectively). No significant changes in weight and waist circumflex have been observed as well (P: 0.970 and 0.361, respectively).

CONCLUSION

Our findings do not support a significant influence of nutrition education program on weight and lipid profile. It seems that the nutrition education program alone is not adequately effective to have beneficial influence on weight and lipid profile. Clinical trial registration No.: IRCT201406215968N3.

Comparison of Fat Mass Percentage and Body Mass Index in Koreans With Spinal Cord Injury According to the Severity and Duration of Motor Paralysis

OBJECTIVE

To analyze the relationship of the change in fat mass percentage (FMP) and body mass index (BMI) with the change in obesity rate according to gender, extent of spinal cord injury (SCI) and the duration.

METHODS

The retrospective study was conducted with medical records of 915 patients. FMP was calculated with BMI and bioelectrical impedance analysis (BIA). Statistical analysis of the relationship between FMP and gender, extent of SCI and the duration after SCI was done.

RESULTS

FMP increased in relation to the duration. The mean FMP was higher in the motor complete tetraplegia group, as compared to the motor incomplete group. The rate of obesity was 69.8% with cutoff FMP values of over 22% and 35% for male and female patients, respectively. Rate of obesity was correlated with the duration after SCI and degree of paralysis. The rate of obesity was 17.1% with a cutoff value of BMI 25 kg/m(2) and 51.3% with a cutoff value of 22 kg/m(2). For evaluation of the diagnostic value of BMI to predict obesity according to FMP standards, a cutoff value of 25 kg/m(2) showed a sensitivity level of 22.3% and specificity level of 94.9%. When the cutoff level for BMI was set at 22 kg/m(2), the sensitivity and specificity were 59.3% and 67.0%, respectively.

CONCLUSION

In Korean SCI patients, FMP showed good correlation with the duration of SCI and the extent of SCI, while BMI did not. Especially in the motor complete tetraplegia group, the diagnostic value of BMI decreased as the duration after SCI increased. This study suggested that FMP could be used complementarily when evaluating the obesity of SCI patients.