Body composition and resting energy expenditure in individuals with spinal cord injury

A lower level of resting energy expenditure (REE) comparing with the
able-bodied people is a big challenge among spinal cord injury (SCI) patients.
With metabolic and physiologic changes combined with physical inactivity, SCI
population is more likely to experience positive energy balance during daily
life which will naturally increase the risk of obesity. Obesity is regarded as
the most common secondary complication, affects SCI patients* health and is
associated with many adverse metabolic. The clinical consequences along with
decreased physical activity as well as unbalance diets all contribute to the
negative changes of body composition and metabolic profiles in people with SCI.
Thus, to investigate the prediction equation of energy expenditure and body
composition in SCI individuals is clearly warranted.
During daily life, REE comprises the greatest proportion (~70%) of total daily
energy expenditure in healthy people and even up to 80% of those sedentary
populations. Considering the limited mobility and sedentary lifestyle, REE
should be paid much attention in people with SCI in order to control their
energy balance and help them to maintain health. In general, body weight and
height are often used for the prediction of REE in health people, but this
seems not a reliable way to estimate the situation in SCI patients. The reason
of this may explained by the changes in body composition and sympathetic
nervous system activity. Fat free mass (FFM) is regards as the most important
and valuable predictor of REE in both healthy and SCI population. This may due
to the numerous high-energy cost processes which occur in organs and muscles.
Good management of REE and obesity in people with SCI is really important for
their health and quality of life. However, to measure REE, expensive devices
are needed and therefore not accessible for large groups. According to the
strong correlation between FFM and REE in people with SCI, it seems feasible to
add FFM into the equation as well as personal and other characteristics for
predicting REE of SCI individuals. To accurately determine the body composition
of individuals with spinal cord injury, a new equation model specified on this
population should be developed. Bioelectrical impedance analysis (BIA) is an
alternative method of dual-energy X-ray absorptiometry (DEXA) scan in measuring
body composition which is more practical and convenient with relatively
reliable results. An equation model based on Bio-impedance analysis should be
developed.

To develop a prediction equation to validly estimate the body composition of
people with a SCI using bioelectrical impedance analysis (BIA)
To develop a prediction equation to validly estimate the resting energy
expenditure of people with a SCI from personal and lesion characteristics and
body composition.

A cross-sectional study will be performed to determine body composition and
REE. During one-time visit for 100 individuals with SCI, DXA and Bod Pod will
be used as gold standard to determine the body composition. The reactance and
resistance outcomes from the BIA together with the personal and lesion
characteristics, will be used to develop a new formula to predict the fat free
mass in people with SCI. Anthropometrics will also take place.
REE will be determined by indirect calorimetry. A multiple linear regression
analysis will be performed to develop predictive REE formulas for SCI
populations. Age, gender, time since injury, level of injury (paraplegia or
tetraplegia), motor completeness, fat mass, fat free mass will be included as
possible predictors in the SCI population.

The total burden and risks in participating in this study are low. Although the
study population is more fragile, no real burdens are put in the participants.
The study consists of 1 visit if approximately 2 hours where personal and
lesion characteristics are collected.
The anthropometric measurements are low in burden, since all measurements are
collected passively in either upright sitting position or supine position.
The radiation during a DXA scan are negligible. The radiation of one full body
scan is less than half the amount of radiation exposed to surrounding
radiation.
All participants will receive a personal report afterwards with outcomes of the
body composition and energy expenditure. This can be considered as valuable
information, especially for these populations.