Year: 2002
Type: dissertation
Study design: Observational Study
Abstract: Only recently has obesity been identified as an important secondary complication of spinal cord injury. Our first objective was to validate a clinical tool to measure body composition in adults with paraplegia. Our second objective was to explore the relationship between body composition and energy metabolism first in neurologically intact adults and then in adults with paraplegia. Our final objective was to compare physical activity levels (PAL) of the latter with recommendations of the World Health Organization. We undertook these studies to better understand changes in energy metabolism associated with spinal cord injury, an important first step in elucidating the underlying mechanisms of obesity in this population. Thirty-one adults with chronic paraplegia and 62 able-bodied adults were recruited. Bioelectrical impedance analysis (BIA) was compared against deuterium dilution for determination of total body water (TBW) and corrected bromide space for extracellular water (ECW). Fat-free mass (FFM) was calculated as TBW/0.732 and fat mass (FM) as weight-FFM. Resting metabolic rate (RMR) and thermic effect of food (TEF) were measured by open-circuit indirect calorimetry and total daily energy expenditure (TDEE) by heart rate monitoring. PAL was calculated as TDEE/RMR. Body mass index (BMI) was a specific but insensitive surrogate measure of obesity in subjects with paraplegia. BIA predicted TBW and ECW reasonably well. RMR was higher in able-bodied men than women, and in able-bodied subjects than those with paraplegia, but not so after adjustment for FFM. Obligatory TEF was not different between able-bodied and paraplegic subjects. PAL of the latter was lower than recommended, and was inversely associated with %FM in men, but not women. Paraplegia is associated with reduced RMR and PAL, both risk factors for obesity, but neither reduced TEF nor compromised metabolic activity of the fat-free body. BMI is insensitive in this population and so body composition should be measured.
Source: TSpace (University of Toronto)
Author: Buchholz, Andrea Christine
Institution: University of Toronto
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7133093158