Gupta, et al. (2005). Body mass index in spinal cord injury... obesity in SCI

[Wise Young]

The authors measured body mass index of 408 patients at the VA Hospital in Wisconsin with a mean duration of 19 years of SCI, median age of 56, and mean age of 55.8. 52.2% were paraplegic and 47.7% were quadriplegic, 46% ASIA A, 11% ASIA B, 12.7% ASIA C, and 29.1% ASIA D. They found that 65.8% were overweight and 29.9% were obese, only 3.6% were undernourished. The authors conlcuded that overweight and obesity are significant problems in this SCI population.

Gupta N, White KT and Sandford PR (2005). Body mass index in spinal cord injury - a retrospective study. Spinal Cord Study design:Retrospective chart review.Objective:To identify the prevalence of overweight and severely overweight (obese) in veterans with spinal cord injury.Setting:Veterans Administration Hospital in Wisconsin.Methods:A retrospective chart review of all the patients registered in the current database with the Spinal Cord Injury Unit in the Veterans Administration Hospital was undertaken Data collected for each patient included age, sex, height, date of assessment of the height, weight, date of assessment of the weight, duration of spinal cord injury and the type of spinal cord injury - paraplegia versus quadriplegia. The body mass index (BMI) was subsequently calculated for each patient and the prevalence of overweight and obesity were determined.Results:There were a total of 408 patients registered in the database with the Spinal Injury Unit. The median age was 56 years, and the mean age 55.8 years. Of all patients with spinal cord injury, 52.2% patients had paraplegia and 47.7% had quadriplegia. The mean duration of injury was 19 years. Of the total number of patients, 46.0% were ASIA A, 11.0% were ASIA B, 12.7% were ASIA C and 29.1% were ASIA D. In all, 27.9% patients had a normal BMI and 3.6% patients were undernourished (BMI less than 18.5 kg/m(2)). The prevalence of overweight was 65.8% and 29.9% patients were obese.Conclusion:Overweight and obesity are problems of a significant magnitude in veterans with spinal cord injury.Spinal Cord advance online publication, 19 July 2005; doi:10.1038/sj.sc.3101790. 1Department of Physical Medicine and Rehabilitation, Clement J Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee, WI, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16030513

[SCI-Nurse]

I would question some of their methodology. We recognize at our center that the BMI is not really valid for people with SCI due to a different proportion of muscle mass than in the general population. Regardless, obesity is a problem in the SCI population we serve, and we all work very hard to help our clients loose weight. It has an impact on everything from their risks factors for cardiac disease and diabetes (high in SCI) to their ability to mobilize their chair, do transfers (without dragging and shearing their butt) and do their ADLs. It is difficult, but with a team approach and a client who wants to do it, reasonable weight loss can be achieved.

(KLD)

[Wise Young]

KLD, what measure would you recommend? There have been a number of recent studies on this subject. Wise.


Tomey KM, Chen DM, Wang X and Braunschweig CL (2005). Dietary intake and nutritional status of urban community-dwelling men with paraplegia. Arch Phys Med Rehabil 86: 664-71. OBJECTIVES: To evaluate nutritional status, dietary intake, nutrition knowledge, and depression of healthy urban men with chronic spinal cord injury (SCI) and to compare these findings with national guidelines and data. DESIGN: Cross-sectional. SETTING: Urban university. PARTICIPANTS: Ninety-five community-dwelling men with paraplegia (age range, 20-59 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dietary intake, body mass index (BMI), waist circumference, knowledge of nutrition, and depression. RESULTS: Diets included too much total and saturated fat, and inadequate fiber, calcium, fruit, and dairy intake. Most participants met protein needs, but most calorie levels were at or below recommendations. By using standard BMI and waist circumference cut-points for the able-bodied, approximately half of participants were overweight, 19% were obese, 7.5% were underweight, and more than one third had large waist circumferences. Participants with low knowledge of nutrition and high BMI who lived alone, smoked, and who had low family incomes were at significantly higher risk for lower quality diets. African Americans had the poorest diets. CONCLUSIONS: Intake of several key nutrients did not meet guidelines, and many BMI and waist circumference values were outside recommended ranges. These data highlight the need for clinicians to screen, counsel, and treat people with SCI to prevent related chronic diseases. Department of Human Nutrition, University of Illinois, Chicago, IL 60612, USA. ktomey@uic.edu http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15827915

Buchholz AC and Bugaresti JM (2005). A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury. Spinal Cord STUDY DESIGN:: Literature review. BACKGROUND:: Increased fat mass and coronary heart disease (CHD) are secondary complications of chronic spinal cord injury (SCI). In able-bodied populations, body mass index (BMI, body weight (kg)/height (m(2))) is a widely used surrogate marker of obesity and predictor of CHD risk. Waist circumference, an accurate and reproducible surrogate measure of abdominal visceral adipose tissue, is also associated with CHD risk (more so than BMI) in able-bodied populations. OBJECTIVE:: To review the literature on the accuracy of BMI and waist circumference as surrogate measures of obesity and CHD risk in persons with chronic SCI. SETTING:: Ontario, Canada. METHODS:: Literature review. RESULTS:: In the SCI population, BMI is an insensitive marker of obesity, explains less of the variance in measured percent fat mass than in the able-bodied, and is inconsistently related to CHD risk factors. This may be due to potential measurement error, and to the inability of BMI to distinguish between fat and fat-free mass and to measure body fat distribution. Waist circumference has not been validated as a surrogate measure of visceral adipose tissue, however preliminary evidence supports a relationship between waist circumference and CHD risk in the SCI population. CONCLUSIONS:: We recommend that SCI-specific BMI classifications be determined. We also recommend that accuracy and reliability of waist circumference as a surrogate measure of visceral adipose tissue and CHD risk be determined in men and women with long-standing paraplegia and tetraplegia.Spinal Cord advance online publication, 12 April 2005; doi:10.1038/sj.sc.3101744. 1Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15824757

Liusuwan A, Widman L, Abresch RT and McDonald CM (2004). Altered body composition affects resting energy expenditure and interpretation of body mass index in children with spinal cord injury. J Spinal Cord Med 27 Suppl 1: S24-8. BACKGROUND: Individuals with spinal cord injury (SCI) typically undergo changes in their body composition (reduction in lean body mass and an increase in fat mass) that can lead to secondary complications associated with diminished physical activity and obesity. METHODS: This study used dual energy X-ray absorptiometry (DXA) to estimate the total lean tissue mass (LTM), total body fat, and total bone mineral content (BMC) to assess the relationship between body mass index (BMI), body composition, and resting metabolic rate (RMR) in a group of children with SCI who were matched with able-bodied controls for age and sex. Body composition and RMR were measured in 18 boys and 9 girls (10-21 years of age) who had a SCI in the previous 1 to 3 years and in 27 age- and sex-matched controls. RESULTS: Children with SCI had significantly lower mean LTM than control subjects (37.6 +/- 9.6 kg and 46.7 +/- 9.2 kg, respectively; P < 0.001) and higher percent body fat (26.4 +/- 7.9% and 20.2 +/- 8.5%, respectively; P < 0.02) as measured by DXA, despite their reduced BMI (18.9 +/- 3.8 kg/m2 and 21.2 +/- 2.9 kg/m2, respectively; P < 0.01). Children with SCI had lower RMR than the controls subjects (1213 +/- 334 kJ/d and 1511 +/- 257 kJ/d, respectively), but there was no difference in RMR when adjusted for LTM. CONCLUSION: Children with SCI have lower RMRs that are associated with their reduced LTM. The reduction in LTM and RMR may predispose children with SCI to relative gains in body fat. BMI significantly underestimates body fat in children with SCI. Shriners Hospitals for Children, Sacramento, California, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15503699

Mamoun L, Puech AM, Manetta J, Badiou S, Paris F, Ohanna F, Rossi M and Sultan C (2004). Circulating leptin concentrations can be used as a surrogate marker of fat mass in acute spinal cord injury patients. Metabolism 53: 989-94. To determine the acute effect of neurological lesion on body composition, plasma leptin level, and the lipid profile, 7 male patients with acute and complete spinal cord injury (SCI) and 9 able-bodied (AB) males were investigated. At 16, 24, 36, and 48 weeks after injury, plasma leptin level and the lipid profile were analyzed, while whole body (WB) and regional fat mass (FM) and fat-free soft tissue (FFST) were measured by dual-energy x-ray absorptiometry (DXA). At all stages, despite no difference being found between both groups for body mass index (BMI), SCI patients had higher FM at WB (P < .01), lower (P < .01), and upper limbs (P < .05), while FFST was lower at WB (P < .05) and lower limbs (P < .01). The leptin level increased gradually from week 24 and was higher at weeks 16, 36, and 48 in SCI patients than in AB patients (7.0 +/- 3.9; 9.7 +/- 5.1; 10.6 +/- 5.3, respectively, v 3.5 +/- 2.5 ng. mL(-1)). SCI patients had lower high-density lipoprotein-cholesterol (HDL-C) (P < .05) and apolipoprotein (apo) A1 (P < .01), while no difference was found for total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), or ApoB levels. At all stages, leptin was strongly and positively correlated with WB and regional FM % (r > 0.75; P < .05) and with TC, LDL-C, and ApoB levels (r > 0.65; P < .05). Leptin was negatively correlated with FFST and the ApoA1/ApoB ratio (r > -0.75; P < .05). In conclusion, neurological lesion induced an early and acute alteration in body composition and lipid profile. The strong relationship between serum leptin and FM suggests that this hormone can be used as a surrogate marker of FM in acute SCI patients and thus would serve as a good indicator for cardiovascular disease risk. Groupe de Recherche Interdisciplinaire Sur le Metabolisme Osseux, Montpellier, France. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15281006

[Wise Young]

and this paper suggests that BMI underestimates body fat in men with spinal cord injury, and thus the incidence of overweight and obesity is greater than what the Wisconsin study suggested.


Jones LM, Legge M and Goulding A (2003). Healthy body mass index values often underestimate body fat in men with spinal cord injury. Arch Phys Med Rehabil 84: 1068-71. OBJECTIVE: To examine the relation between body mass index (BMI) and adiposity in men with spinal cord injury (SCI). DESIGN: Cross-sectional study. SETTING: Outpatient study in 2 centers in New Zealand. PARTICIPANTS: Nineteen men with traumatic SCI were age-, height-, and weight-matched with 19 able-bodied men. INTERVENTIONS: Not applicable.Main Outcome Measures: BMI (kg/m(2)) and dual-energy x-ray absorptiometry measures of total and regional lean tissue mass and fat mass. RESULTS: Although the groups had similar BMIs, the total lean tissue mass was 8.9kg lower (95% confidence interval [CI], -12.7 to -5.2; P<.001) whereas total fat mass was 7.1kg greater (95% CI, 1.3-12.8; P<.05) in the SCI group. Body fat percentage was 9.4% (95% CI, 3.6-15.1; P<.01) greater in the SCI group. Regional measures showed a similar pattern. Truncal fat mass increased 3.7kg (95% CI, 0.5-6.9; P<.05) in the SCI group compared with controls. CONCLUSIONS: Body fat mass was greater for any given BMI in the SCI group. Many patients with SCI do not appear to be obese, yet they carry large amounts of fat tissue. BMI is widely used to estimate adiposity, but it may underestimate body fat in men with SCI. School of Physical Education, University of Otago, Dunedin, New Zealand. ljones@pooka.otago.ac.nz http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12881836

[SCI-Nurse]

Yes, we have found that we have to fudge the BMI as it under-reports true obesity in people with SCI.

(KLD)

[Sue Pendleton]

Fudge? This is great. I mean these studies seem to be ideal to prove that insurance should help pay for a tummy tuck using the inner corset method. Man, they actually don't realize the quad gut, para belly thing when doing these studies and adjust for them?

Oh geez, now I feel fat again.

[Lewis]

Fudge? This is great. I mean these studies seem to be ideal to prove that insurance should help pay for a tummy tuck using the inner corset method. Man, they actually don't realize the quad gut, para belly thing when doing these studies and adjust for them?

Oh geez, now I feel fat again.

Did someone say fudge?!