Resting energy expenditure during spinal cord injury rehabilitation and utility of fat-free mass-based energy prediction equations: a pilot study

Spinal Cord Series and Cases, 2024 · DOI: https://doi.org/10.1038/s41394-024-00682-x · Published: September 20, 2024

Simple Explanation

Following a spinal cord injury (SCI), the body's energy needs often decrease, mainly due to a reduction in resting energy expenditure (REE). This is the energy required to sustain basic life processes. This reduction in REE is primarily caused by changes in body composition, specifically a loss of fat-free mass (FFM) and an increase in fat mass (FM). Clinicians often struggle to accurately estimate energy needs in SCI patients without using indirect calorimetry, a method not always accessible. Researchers are working on SCI-specific prediction equations that consider FFM to improve accuracy.

Study Duration

Between weeks 4–6 post-spinal cord injury, repeated at week 8 and every 4 weeks thereafter until week 20

Participants

Fifteen people (mean age 35 ± 13 years, 67% paraplegic)

Evidence Level

Longitudinal observational study

Key Findings

1
Mean REE, weight, and body composition remained unchanged during SCI rehabilitation (between weeks 4 and 20 post-injury).
2
SCI-specific BMR prediction equations, particularly the Chun and Nightingale equations, performed well in predicting REE during rehabilitation.
3
Clinical factors such as spasticity, medication changes, and infections were prevalent but inconsistently associated with changes in individual REE.

Research Summary

This pilot study observed REE and body composition in males undergoing SCI rehabilitation, comparing measured REE with SCI-specific REE prediction equations incorporating FFM. The study found no significant changes in mean REE, weight, or body composition between weeks 4 and 20 of injury. SCI-specific BMR prediction equations, like those developed by Chun et al. and Nightingale & Gorgey, performed well against measured REE during the rehabilitation admission.

Practical Implications

Clinical Practice

FFM-based BMR prediction equations may be a viable alternative to indirect calorimetry for estimating energy needs in SCI rehabilitation settings.

Research

Future research should avoid relying on single indirect calorimetry measures, as they may not accurately represent typical REE in this population. Multiple measures over time are recommended.

Study Design

Future study protocols should incorporate routine monitoring and reporting of clinical factors to support accurate interpretation of indirect calorimetry data.

Study Limitations

1
Recruitment challenges and small sample size.
2
Inclusion of people with non-traumatic SCI, incomplete injuries (AIS D) and a higher BMI may have increased heterogeneity in the outcome measures.
3
Inclusion of males only is also a limitation.

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