Measured and predicted resting energy expenditure in wheelchair rugby athletes

Objective: Report measured resting energy expenditure (REE) in wheelchair rugby athletes and evaluate agreement between REE and the prediction models of Chun, Cunningham, Harris-Benedict, Mifflin, Nightingale and Gorgey, and Owen.

Design: Cohort-based validation study.

Setting. Paralympic team training camp.

Participants: Fourteen internationally competitive athletes who play wheelchair rugby, 13 of whom had cervical spinal cord injuries (SCI).

Outcome Measures: A portable metabolic analyzer was used to measure REE following an overnight fast and dual-energy X-ray absorptiometry (DXA) was used to assess lean body mass for the prediction equations.

Results: REE in the current sample was 1735?±?257?kcal?×?day^?1 ranging from 1324 to 2068?kcal?×?day^{?1 Bhambhani Y. Physiology of wheelchair racing in athletes with spinal cord injury. Sports Med 2002;32(1):23–51.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]}. Bland–Altman analyses revealed negative mean bias but similar limits of agreement between measured REE and scores predicted by Chun, Cunningham, Mifflin, Nightingale and Gorgey, and Owen models in elite athletes who play wheelchair rugby.

Conclusion: Prediction models regressed on persons with and without SCI under-predicted REE of competitive wheelchair rugby athletes. This outcome may be explained by the higher REE/fat-free mass (FFM) ratio of current athletes compared to less active samples. Findings from the current study will help practitioners to determine nutrient intake needs on training days of varied intensity.     

Management of obesity after spinal cord injury: a systematic review

Context: Individuals with chronic spinal cord injury (SCI) are susceptible to central and visceral obesity and it’s metabolic consequences; consensus based guidelines for obesity management after SCI have not yet been stablished.

Objectives: To identify and compare effective means of obesity management among SCI individuals.

Methods: This systematic review included English and non-English articles, published prior to April 2017 found in the PubMed/Medline, Embase, CINAHL Psychinfo and Cochrane databases. Studies evaluating any obesity management strategy, alone or in combination, including: diet therapy, voluntary and involuntary exercise such as neuro-muscular electric stimulation (NMES), pharmacotherapy, and surgery, among individuals with chronic SCI were included. Outcomes of interest were reductions in waist circumference, body weight (BW), body mass index (BMI) and total fat mass (TFM) and increases in total lean body mass (TLBM) from baseline. From 3,553 retrieved titles and abstracts, 34 articles underwent full text review and 23 articles were selected for data abstraction. Articles describing weight loss due to inflammation, cancer or B12 deficiency were excluded. The Downs and Black reported poor to moderate quality of the studies.

Results: Bariatric surgery produced the greatest permanent weight reduction and BMI correction followed by combinations of physical exercise and diet therapy. Generally, NMES and pharmacotherapy improved TLBM and reduced TFM but not weight.

Conclusions: The greatest weight reduction and BMI correction was produced by bariatric surgery, followed by a combination of physical exercise and diet therapy. NMES and pharmacologic treatment did not reduce weight or TFM but increased in TLBM.     

男性胃癌病人围手术期静息能量消耗特点

目的观察男性胃癌病人围手术期静息能量消耗（energy expenditureanalysis REE）特点。方法选择拟手术男性胃癌病人39例为研究对象，应用间接测热仪分别测定病人术前及术后第1天的REE，双能源x线吸收法（DEXA）测定人体组成，同时用简易营养评价法（MNA）对胃癌病人行营养评价。结果患者术前REE较H-B公式预测值低，与瘦体含量（LBM）呈明显正相关（r=0.635，P〈0．01），不同营养状态的男性胃癌患者其术前REE及瘦体量有明显差异，而每千克瘦体的REE无明显差异，术后REE明显高于术前，术后呼吸商明显低于术前，差异有统计学意义。结论男性胃癌患者术前静息能量消耗下降，下降程度与患者瘦体丢失密切相关，术后代谢支持应适当地增加能量供应并调节各种营养物质的比例。     

Comparison of methods to assess energy expenditure and physical activity in people with spinal cord injury

Objective

To compare different methods of assessing energy expenditure (EE) and physical activity (PA) in people with spinal cord injury (SCI) under community-dwelling conditions.

Methods

A reference standard encompassing the doubly labelled water (DLW) technique, heart rate monitoring (FLEX-HR), a multi-sensor armband (SenseWear Armband (SWA)), and two PA recall questionnaires were employed in 14 people with SCI to estimate EE and leisure-time PA.

Results

Mean total daily energy expenditure (TDEE) assessed by DLW, FLEX-HR, and SWA were 9817 ± 2491 kJ/day, 8498 ± 1516 kJ/day, and 11414 ± 3242 kJ/day, respectively. Physical activity energy expenditure (PAEE) quantified by DLW was 2841 ± 1626 kJ/day, 2935 ± 1732 kJ/day estimated from FLEX-HR, and 2773 ± 2966 kJ/day derived from SWA. After converting the PA recall questionnaire data to EE in kJ/day, PAEE for the Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) was 2339 ± 1171 kJ/day and for Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) 749 ± 1026 kJ/day. DLW-quantified PAEE was moderately associated with PARA-SCI (R² = 0.62, P < 0.05), but not with the other estimates of PAEE (R² ranged between 0.13 and 0.30, P > 0.05).

Conclusion

Our findings revealed that the PARA-SCI recall questionnaire was the best estimate of PAEE compared to the reference standard DLW approach. Although the between-method variability for SWA, FLEX-HR, and PASIPD-derived PAEE was small, there was a weak association between these methods and the criterion DLW technique. The best estimate of DLW-quantified TDEE was by FLEX-HR. SWA significantly overestimated TDEE in this population.     

Comparison of nutritional intake between individuals with acute and chronic spinal cord injury

Objective

To compare the nutritional intake of patients with acute and chronic spinal cord injury (SCI).

Design

Cross-sectional, observational study.

Setting

Spinal cord unit.

Methods

Twelve in-house patients of a spinal cord unit with acute SCI and paralysis duration of 5.3 ± 2.5 months (acute group) were compared with 12 subjects with chronic SCI (chronic group) with lesion duration of 55.5 ± 21.0 months. All subjects recorded their nutritional intake for 7 days, which was analyzed for intake of energy, proteins, fat, carbohydrates, vitamins, mineral nutrients, fluid, and dietary fiber. Resting energy expenditure (REE) and total body fat were also determined.

Results

The chronic group showed a significantly higher total body fat content compared to the acute group (19.4 ± 3.8 vs. 15.7 ± 4.3%). All other parameters were not significantly different between groups. Both groups ingested excessive fat and insufficient amounts of carbohydrates compared with common nutritional recommendations. Low intakes of vitamins C, D, E, biotin, folic acid, as well as potassium and iron were found.

Conclusions

No differences were found in the nutritional intakes of two comparable groups of subjects with acute and chronic SCI. Independent of lesion duration, subjects with SCI showed considerable deviations from the general accepted nutritional recommendations concerning macro- and micronutrients intake. Professional nutritional education for persons with SCI should start as soon as possible after injury to prevent nutrition-related secondary complications like cardiovascular diseases. Periodic determinations of body fat content and REE combined with a physical activity program might be helpful as well.     

Comparison of nutritional intake between individuals with acute and chronic spinal cord injury

Abstract

Objective

To compare the nutritional intake of patients with acute and chronic spinal cord injury (SCI).

Design

Cross-sectional, observational study.

Setting

Spinal cord unit.

Methods

Twelve in-house patients of a spinal cord unit with acute SCI and paralysis duration of 5.3 ± 2.5 months (acute group) were compared with 12 subjects with chronic SCI (chronic group) with lesion duration of 55.5 ± 21.0 months. All subjects recorded their nutritional intake for 7 days, which was analyzed for intake of energy, proteins, fat, carbohydrates, vitamins, mineral nutrients, fluid, and dietary fiber. Resting energy expenditure (REE) and total body fat were also determined.

Results

The chronic group showed a significantly higher total body fat content compared to the acute group (19.4 ± 3.8 vs. 15.7 ± 4.3%). All other parameters were not significantly different between groups. Both groups ingested excessive fat and insufficient amounts of carbohydrates compared with common nutritional recommendations. Low intakes of vitamins C, D, E, biotin, folic acid, as well as potassium and iron were found.

Conclusions

No differences were found in the nutritional intakes of two comparable groups of subjects with acute and chronic SCI. Independent of lesion duration, subjects with SCI showed considerable deviations from the general accepted nutritional recommendations concerning macro- and micronutrients intake. Professional nutritional education for persons with SCI should start as soon as possible after injury to prevent nutrition-related secondary complications like cardiovascular diseases. Periodic determinations of body fat content and REE combined with a physical activity program might be helpful as well.     

Resting energy expenditure after Roux-en Y gastric bypass surgery

Background

The mechanisms by which Roux-en Y gastric bypass surgery (RYGB) provokes weight loss are incompletely understood. Enhanced energy expenditure may be one contributing mechanism. Previous results on changes in resting energy expenditure (REE) after RYGB are inconsistent.

Weight change after spinal cord injury

Objectives: To study the patterns of weight change after spinal cord injury (SCI) and identify associated risk factors.

Study design: Cohort study.

Setting: Sixteen Spinal Cord Injury Model Systems (SCIMS), USA.

Participants: One thousand and ninety-four individuals with an SCI who were entered into the SCIMS and had a 1-year follow-up between October 2006 and November 2012.

Intervention: Not applicable.

Outcome measure: Change in body mass index (BMI) during the first year of injury. Height and weight were assessed during inpatient rehabilitation and 1 year after injury.

Results: Mean BMI decreased from 26.3 to 25.8?kg/m² during the first year after SCI (mean change: ?0.5?kg/m² (standard deviation: 3.58)). Weight loss was mainly observed among individuals classified as overweight or obese during rehabilitation (n = 576) with a BMI decrease of 1.4?kg/m², which varied significantly by sex, education, neurological level, and the presence of vertebral injury. Weight gain was noted among individuals classified as underweight or normal weight during rehabilitation (n?=?518) with a BMI increase of 0.5?kg/m², with the greatest increase among individuals of Hispanic origin (1.2?kg/m²), other marital status (1.2?kg/m²), age group 31–45 years (1.1?kg/m²), with less than high school education (1.1?kg/m²), without spinal surgery (0.9?kg/m²), and with motor functionally incomplete injury (0.8?kg/m²).

Conclusion: Our findings suggest that strategies for weight management should be addressed after a SCI to ameliorate the potential for unhealthful weight change, particularly among at-risk groups.     

Factors associated with past and current employment of veterans with spinal cord injury

Objective: The purpose of this study was to examine variables predictive of post-SCI return to employment and current employment among a large cohort of veterans with Spinal Cord Injury (SCI) treated within the Veterans Health Administration (VHA) SCI System of Care.Design: Cross sectional analysis of data obtained during in-person baseline interviews and follow-up phone interviews.Setting: Seven SCI Centers within Veteran Affairs Medical Centers.Participants: 1047 veterans with SCI receiving inpatient or outpatient care in VHA.Results: Only 29.8% were employed post-SCI, 27.9% reported employment within the immediate 5 years before the baseline interview, but only 9.2% reported current employment at the time of the baseline interview. Significant predictors of current employment among these veterans with SCI included recent employment experience, history of legal problems, duration of SCI, education, and life satisfaction.Conclusions: The baseline employment rate following SCI of a large, representative sample, was 29.8%. Greater duration of SCI predicted unemployment, likely due to the older age of this population. Additional years of education promoted current and post-SCI employment, while a history of legal problems was a barrier to employment.     

Secondary health conditions and disability among people with spinal cord injury: A prospective cohort study

Objective: To examine how secondary health conditions (SHCs) that develop early after a spinal cord injury (SCI) are related to disability over time.Design: Prospective cohort study.Setting: Two spinal units in New Zealand (Burwood Spinal Unit and Auckland Spinal Rehabilitation Unit).Participants: Between 2007 and 2009, 91 people participated in three telephone interviews approximately 6, 18, and 30 months after the occurrence of a SCI.Outcome measures: SHCs were measured using 14 items derived from the Secondary Complications Survey. Disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Linear regression analyses were performed to investigate associations between SHCs at 6 months and disability at each assessment point.Results: The most prevalent SHCs were leg spasms, constipation, back pain, pain below the level of SCI, and shoulder pain. Constipation, urinary tract infection, and headaches at 6 months post-SCI were associated with significantly higher levels of disability at each subsequent follow-up, independent of age, sex and SCI impairment. Back pain, and pain below the SCI, at 6 months were associated with significantly greater disability at 18 months, and difficulty coughing at 6 months was associated with significantly greater disability at 30 months.Conclusion: The experience of specific SHCs in the first 6 months after an SCI is related to greater long-term disability. In order to reduce the disability burden of people with SCI, efforts should be directed toward early prevention of these SHCs.     

Open-heart operations in patients with a spinal cord injury

BACKGROUND: The objective of our study was to evaluate the outcomes of open-heart surgery in patients with a spinal cord injury. METHODS: A retrospective analysis of all patients (n = 8) with a spinal cord injury who underwent open-heart operations in a single institution from April 1994 to November 2006 was conducted. RESULTS: All patients had a permanent spinal cord injury with levels ranging from T3 to L2 with a mean age of 62 years (range, 47-72). Seven coronary artery bypass operations and 2 aortic valve replacements were performed. The mean cardiac ejection fraction was 44% (range, 20-60). Seventy-five percent of the patients were extubated within 24 hours of the operation. A decubitus ulcer occurred in only 1 patient. The acute hospital stay averaged 14 days (range, 6-36). One patient died from multiorgan failure on postoperative day 13 giving an in-hospital 30-day mortality of 12.5%. The 5-year survival was 75% with a mean follow-up of 67 months (range, .5-129). CONCLUSIONS: Open-heart operations in patients with a spinal cord injury can be performed safely with acceptable early and late outcomes.     

Lean tissue mass and energy expenditure are retained in hypogonadal men with spinal cord injury after discontinuation of testosterone replacement therapy

Abstract

Objective

To determine whether favorable changes to lean tissue mass (LTM), resting energy expenditure (REE), and testosterone (T) that occurred with 12 months of physiological testosterone replacement therapy (TRT) were retained 6 months after discontinuing treatment.

Design

Prospective, open-label, controlled drug intervention trial.

Setting

Metropolitan area hospitals.

Subjects

Eugonadal (n = 11) and hypogonadal (n = 13) men with chronic spinal cord injury (SCI).

Interventions

Hypogonadal subjects received a 5 or 10 mg transdermal T patch daily for 12 months, with adjustment of the dose to normalize the serum T concentration; TRT was discontinued after 12 months (TRT-12M) and subjects were followed for an additional 6 months and re-evaluated (Post-TRT). Total body dual energy X-ray absorptiometry and blood draws were performed at baseline (BL) prior to TRT, TRT-12M, and Post-TRT. Eugonadal subjects did not receive treatment and were evaluated at comparable time points.

Results

There were no significant differences between groups prior to TRT at BL for any of the study endpoints. In the hypogonadal group, a significant increase in LTM was observed from BL to TRT-12M (50.2 ± 7.4 vs. 52.9 ± 6.8 kg, P < 0.01), which persisted Post-TRT compared to BL (52.2 ± 7.8 kg, P < 0.05). The increase in REE from BL to TRT-12M (1283 ± 246 vs. 1410 ± 250 kcal/day) was also retained at Post-TRT (1393 ± 220 kcal/day). These sustained improvements in LTM and REE after termination of anabolic hormonal therapy may be associated with persistent beneficial effects on health and physical function of hypogonadal men with chronic SCI.     

Lean tissue mass and energy expenditure are retained in hypogonadal men with spinal cord injury after discontinuation of testosterone replacement therapy

Objective

To determine whether favorable changes to lean tissue mass (LTM), resting energy expenditure (REE), and testosterone (T) that occurred with 12 months of physiological testosterone replacement therapy (TRT) were retained 6 months after discontinuing treatment.

Design

Prospective, open-label, controlled drug intervention trial.

Setting

Metropolitan area hospitals.

Subjects

Eugonadal (n = 11) and hypogonadal (n = 13) men with chronic spinal cord injury (SCI).

Interventions

Hypogonadal subjects received a 5 or 10 mg transdermal T patch daily for 12 months, with adjustment of the dose to normalize the serum T concentration; TRT was discontinued after 12 months (TRT-12M) and subjects were followed for an additional 6 months and re-evaluated (Post-TRT). Total body dual energy X-ray absorptiometry and blood draws were performed at baseline (BL) prior to TRT, TRT-12M, and Post-TRT. Eugonadal subjects did not receive treatment and were evaluated at comparable time points.

Results

There were no significant differences between groups prior to TRT at BL for any of the study endpoints. In the hypogonadal group, a significant increase in LTM was observed from BL to TRT-12M (50.2 ± 7.4 vs. 52.9 ± 6.8 kg, P < 0.01), which persisted Post-TRT compared to BL (52.2 ± 7.8 kg, P < 0.05). The increase in REE from BL to TRT-12M (1283 ± 246 vs. 1410 ± 250 kcal/day) was also retained at Post-TRT (1393 ± 220 kcal/day). These sustained improvements in LTM and REE after termination of anabolic hormonal therapy may be associated with persistent beneficial effects on health and physical function of hypogonadal men with chronic SCI.     

TRH对大鼠脊髓损伤后SCBF和SEP的影响

脊髓损伤（ＳＣＩ）后内源性阿片肽释放，并参与脊髓的继发损伤机制。ＴＲＨ可阻断阿片肽的自主神经效应，而不影响痛觉。本实验探讨大剂量ＴＲＨ（２ｍｇ／ｋｇ／ｈ）治疗对大鼠脊髓打击伤（Ａｌｌｅｎｓ法１０ｇｘ５ｃｍ）后脊髓血流量（ＳＣＢＦ）和脊髓诱发电位（ＳＥＰ）的影响。脊髓损伤后１ｈ，ＳＣＢＦ开始显著下降，持续至伤后２４ｈ，ＳＥＰ峰潜时呈进行性延长趋势；伤后即刻静脉注射ＴＲＨ（２ｍｇ／ｋｇ／ｈ，共５次），可使伤后即刻和２４ｈ的ＳＣＢＦ显著升高，并使伤后ＳＣＢＦ下降时间延迟３ｈ，同时ＳＥＰ峰潜时有不同程度改善。结果表明，ＴＲＨ对受伤脊髓早期有一定的防治作用，并具有一定的后发效应；同时也可促进脊髓的神经传导功能。本文亦对ＴＲＨ治疗ＳＣＩ的病理生物学机制进行了讨论。     

应用改进封闭脊髓窗技术活体观察脊髓损伤后脊髓微循环变化

目的:探讨应用改进的封闭脊髓窗技术活体观察大鼠脊髓损伤后脊髓微循环变化的可行性及效果.方法:改进传统的脊髓窗,设计带有打击探头的脊髓窗.45只SD大鼠随机分为对照组(n=20)和实验组(n=25).实验组大鼠脊髓窗安装完成后进行窗内打击脊髓,然后即时观察并记录打击后2h内打击点周围微动脉直径的变化.对照组大鼠在脊髓窗安装完成后不进行打击,只对脊髓微动脉直径进行连续2h观察并记录.术后两组大鼠进行BBB运动功能评分,处死动物取脊髓标本切片,HE染色,观察脊髓组织改变情况.结果:实验组大鼠打击点周围2～6mm的微动脉直径在打击后10min、30min、1h、2h各时间点均较打击前明显减小,术后2d及7d时BBB功能评分明显低于术前,病理切片可见脊髓打击区神经组织变性液化.对照组大鼠在观测开始及结束时脊髓微动脉直径无明显变化,术后BBB评分与术前BBB评分均为21分,病理切片未见脊髓损伤表现.结论:改进的封闭脊髓窗技术可以有效地实现窗内打击脊髓,并可以安全地对脊髓表面微血管进行活体观测.脊髓表面打击点周围2～6mm的微动脉在脊髓损伤后10min即发生痉挛.     

儿童无放射学影像异常的脊髓损伤14例临床分析

目的：提高对儿童无放射学影像异常的脊髓损伤（spinal cord injury without radiographic abnormality，SCIWORA）的认识。方法：对1992年1月至2005年8月北京儿童医院住院患者中诊断为“急性脊髓炎”或“脊髓损伤”的187例进行回顾性分析，发现其中14例为SCIWORA。男6例，女8例。年龄1岁3个月～15岁（15岁1例，1岁3个月～7岁13例）。均有明确外伤史。损伤水平在C6～T9，颈髓2例，胸髓12例。脊髓功能ASIA分级：A级9例，C级4例，D级1例。脊柱X线片和CT未见骨折及脱位；MRI检查示脊髓水肿9例,脊髓出血2例，脊髓挫伤3例。采用综合治疗，包括卧床、局部制动，应用激素、脱水剂、神经营养药等。结果：4例患者失访，10例患者随访6个月～5年，平均2年3个月，4例（C级3例，D级1例）患者（均为MRI显示水肿局限者）在伤后6个月运动、感觉及括约肌功能完全恢复（E级）；6例（A级）患者运动、感觉及括约肌障碍未恢复。2例（A级）病初MRI表现为脊髓弥漫水肿者，伤后4～6个月复查MRI脊髓呈萎缩样改变。结论：对怀疑SCIWORA的儿童，应首选MRI检查。脊髓水肿局限者预后好，水肿弥漫或伴有出血、挫伤者预后差。     

Influence of inhalation injury on energy expenditure in severely burned children

ObjectiveDetermine the effect of inhalation injury on burn-induced hypermetabolism in children.DesignProspective study comparing hypermetabolism (i.e., resting energy expenditure and oxygen consumption) in burned children with and without inhalation injury during acute hospitalization.SettingSingle pediatric burn center.PatientsEighty-six children (1–18 years) with ≥40% total body surface area burns were stratified to two groups: no inhalation injury and inhalation injury.InterventionsNone.Main measurements and resultsInhalation injury was diagnosed based on bronchoscopic evaluation. At admission, PaO₂:FiO₂ ratios (an index of respiratory distress) were significantly higher in patients with no inhalation injury than in patients with inhalation injury. No differences were detected in resting energy expenditure or percent of the predicted basal metabolic rate between groups. Additionally, oxygen consumption did not significantly differ between groups.ConclusionsInhalation injury does not augment the burn-induced hypermetabolic stress response in children, as reflected by resting energy expenditure and oxygen consumption.     

Effect of mannitol in a patient with spinal cord injury

Summary Relief of spinal cord compression following mannitol infusion is reported in a patient with a thoracic compression fracture.     

Weight gain following spinal cord injury: a pilot study

Study design

Retrospective chart review.

Objective

To define the temporal course of weight gain in persons with new spinal cord injury (SCI), and to identify predictors of weight gain in this population.

Setting

A United States Department of Veterans Affairs (VA) SCI Unit.

Methods

A retrospective chart review in a VA SCI Unit was conducted. Participants (n = 85) included all persons with new SCI completing initial rehabilitation at the center between 1998 and 2006. Outcome measures were mean change in body mass index (BMI) between rehabilitation admission and final follow-up, time of greatest BMI change, and distribution of participants by BMI classification. These measures were also examined relative to SCI level, American Spinal Injury Association Impairment Scale (AIS) grade, primary mode of mobility, and age at rehabilitation admission.

Results

Mean BMI increased by 2.3 kg/m² between rehabilitation admission (mean 45 days post-injury) and final follow-up (mean 5 years post-injury). The distribution of participants shifted from lower BMI classifications at rehabilitation admission to higher BMI classifications at final follow-up. For participants transitioning from normal to overweight or obese, the greatest increase occurred during the first year after acute rehabilitation. Neurological level, impairment category, primary mode of mobility, and age at rehabilitation admission did not significantly predict BMI change. BMI at rehabilitation admission correlated significantly with BMI at final follow-up (P < 0.0005).

Conclusions

These findings confirm a significant increase in BMI after new SCI and suggest that persons with new SCI are at greatest weight gain risk during the first year following acute rehabilitation.