scholarly journals A Primary Care Provider’s Guide to Diet and Nutrition After Spinal Cord Injury

2020 ◽  
Vol 26 (3) ◽  
pp. 197-202
Author(s):  
David R. Gater ◽  
Craig Bauman ◽  
Rachel Cowan
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Energy Balance ◽  
Energy Expenditure ◽  
Caloric Intake ◽  
Positive Energy ◽  
Body Composition Assessment ◽  
Nutrient Density ◽  
Cord Injury ◽  
Positive Energy Balance

Physiological changes that occur after spinal cord injury (SCI) are profound and affect almost every organ system in the human body. Energy balance is significantly altered due to motor paralysis, spasticity or flaccidity, neurogenic sarcopenia, neurogenic osteopenia, sympathetic nervous system disruption, and blunted anabolism. Energy expenditure is markedly reduced, whereas hypothalamic control of appetite and satiety is diminished, resulting in discordant energy intake. Ultimately, neurogenic obesity ensues as the result of a positive energy balance. Even though nutritional guidelines for persons with SCI have been available since 2009, the necessity for body composition assessment and total daily energy expenditure was insufficiently addressed such that most individuals with SCI continued in positive energy balance despite “adherence” to the guidelines. Macronutrients must be carefully assessed to optimize caloric intake, while micronutrient consumption may need to be supplemented in order to meet recommended daily allowances. Such a diet would emphasize foods with low caloric yet high nutrient density. This article reviews current literature regarding nutritional requirements for SCI and provides a straightforward plan for implementing more rigorous dietary interventions meant to address the obesity crisis in this especially vulnerable population.

scholarly journals Energy Expenditure Following Spinal Cord Injury: A Delicate Balance

2021 ◽  
Vol 27 (1) ◽  
pp. 92-99
Author(s):  
Gary J. Farkas ◽  
Alicia Sneij ◽  
David R. Gater
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Energy Expenditure ◽  
Metabolic Rate ◽  
Clinical Care ◽  
Accurate Determination ◽  
Caloric Intake ◽  
Standard Of Care ◽  
Cord Injury

Following a spinal cord injury (SCI), neurogenic obesity results from changes in body composition, physical impairment, and endometabolic physiology and when dietary intake exceeds energy expenditure. Given the postinjury reductions in lean body mass, sympathetic nervous system dysfunction, and anabolic deficiencies, energy balance is no longer in balance, and thereby an obesogenic environment is created that instigates cardiometabolic dysfunction. Accurate determination of metabolic rate can prevent excess caloric intake while promoting positive body habitus and mitigating obesity-related comorbidities. Metabolic rate as determined by indirect calorimetry (IC) has not been adopted in routine clinical care for persons with SCI despite several studies indicating its importance. This article reviews current literature on measured and predicted metabolic rate and energy expenditure after SCI and stresses the importance of IC as standard of care for persons with SCI.

Obesity: A Game of Inches

PEDIATRICS ◽  
1995 ◽  
Vol 95 (1) ◽  
pp. 131-132
Author(s):  
Rudolph L. Leibel
Keyword(s):  
Weight Gain ◽  
Energy Balance ◽  
Energy Expenditure ◽  
Energy Intake ◽  
Caloric Intake ◽  
Normal Growth ◽  
Positive Energy ◽  
Long Period ◽  
Positive Energy Balance ◽  
Diet History

Obesity, like baseball, is a game of inches. Weight gain cannot occur unless energy intake exceeds energy expenditure. Such positive energy balance is a sine qua non for normal growth in the child, and for obesity in the adult. Very small excesses of intake over expenditure can make a big difference if present over a long period of time. Consider the children in the study reported by Klesges et al1 elsewhere in this journal (pages 126-130). At about 4½ years of age, these children were estimated (by diet history) to have been ingesting about 2000 kcal per day. This is almost certainly an overestimate of the actual caloric intake of these children (see below).

scholarly journals The effect of breakfast on appetite regulation, energy balance and exercise performance

2015 ◽  
Vol 75 (3) ◽  
pp. 319-327 ◽  
Author(s):  
David J. Clayton ◽  
Lewis J. James
Keyword(s):  
Energy Balance ◽  
Energy Expenditure ◽  
Energy Intake ◽  
Exercise Performance ◽  
Intervention Studies ◽  
Precise Determination ◽  
Positive Energy ◽  
Cross Sectional ◽  
Positive Energy Balance ◽  
The Impact

The belief that breakfast is the most important meal of day has been derived from cross-sectional studies that have associated breakfast consumption with a lower BMI. This suggests that breakfast omission either leads to an increase in energy intake or a reduction in energy expenditure over the remainder of the day, resulting in a state of positive energy balance. However, observational studies do not imply causality. A number of intervention studies have been conducted, enabling more precise determination of breakfast manipulation on indices of energy balance. This review will examine the results from these studies in adults, attempting to identify causal links between breakfast and energy balance, as well as determining whether consumption of breakfast influences exercise performance. Despite the associations in the literature, intervention studies have generally found a reduction in total daily energy intake when breakfast is omitted from the daily meal pattern. Moreover, whilst consumption of breakfast supresses appetite during the morning, this effect appears to be transient as the first meal consumed after breakfast seems to offset appetite to a similar extent, independent of breakfast. Whether breakfast affects energy expenditure is less clear. Whilst breakfast does not seem to affect basal metabolism, breakfast omission may reduce free-living physical activity and endurance exercise performance throughout the day. In conclusion, the available research suggests breakfast omission may influence energy expenditure more strongly than energy intake. Longer term intervention studies are required to confirm this relationship, and determine the impact of these variables on weight management.

scholarly journals Wearable Sensors in Ambulatory Individuals With a Spinal Cord Injury: From Energy Expenditure Estimation to Activity Recommendations

2019 ◽  
Vol 10 ◽  
Author(s):  
Werner L. Popp ◽  
Sophie Schneider ◽  
Jessica Bär ◽  
Philipp Bösch ◽  
Christina M. Spengler ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Energy Expenditure ◽  
Wearable Sensors ◽  
Cord Injury ◽  
Activity Recommendations

scholarly journals Murine neuronatin deficiency is associated with a hypervariable food intake and bimodal obesity

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Irene Cimino ◽  
Debra Rimmington ◽  
Y. C. Loraine Tung ◽  
Katherine Lawler ◽  
Pierre Larraufie ◽  
...  
Keyword(s):  
Body Weight ◽  
Energy Balance ◽  
Food Intake ◽  
Energy Expenditure ◽  
Positive Energy ◽  
Chow Diet ◽  
Chromatin Regulator ◽  
Positive Energy Balance ◽  
The Impact ◽  
Deficient Mice

AbstractNeuronatin (Nnat) has previously been reported to be part of a network of imprinted genes downstream of the chromatin regulator Trim28. Disruption of Trim28 or of members of this network, including neuronatin, results in an unusual phenotype of a bimodal body weight. To better characterise this variability, we examined the key contributors to energy balance in Nnat+/−p mice that carry a paternal null allele and do not express Nnat. Consistent with our previous studies, Nnat deficient mice on chow diet displayed a bimodal body weight phenotype with more than 30% of Nnat+/−p mice developing obesity. In response to both a 45% high fat diet and exposure to thermoneutrality (30 °C) Nnat deficient mice maintained the hypervariable body weight phenotype. Within a calorimetry system, food intake in Nnat+/−p mice was hypervariable, with some mice consuming more than twice the intake seen in wild type littermates. A hyperphagic response was also seen in Nnat+/−p mice in a second, non-home cage environment. An expected correlation between body weight and energy expenditure was seen, but corrections for the effects of positive energy balance and body weight greatly diminished the effect of neuronatin deficiency on energy expenditure. Male and female Nnat+/−p mice displayed subtle distinctions in the degree of variance body weight phenotype and food intake and further sexual dimorphism was reflected in different patterns of hypothalamic gene expression in Nnat+/−p mice. Loss of the imprinted gene Nnat is associated with a highly variable food intake, with the impact of this phenotype varying between genetically identical individuals.

Energy Expenditure in Individuals with Spinal Cord Injury Quantified by Doubly Labeled Water and a Multi-Sensor Armband

2015 ◽  
Vol 12 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Ricardo A. Tanhoffer ◽  
Aldre I.P. Tanhoffer ◽  
Jacqueline Raymond ◽  
Nathan A. Johnson ◽  
Andrew P. Hills ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Energy Expenditure ◽  
Doubly Labeled Water ◽  
Cord Injury

Body composition assessment in spinal cord injury subjects

2003 ◽  
Vol 40 (0) ◽  
pp. s183-s186 ◽  
Author(s):  
M. Maggioni ◽  
S. Bertoli ◽  
V. Margonato ◽  
G. Merati ◽  
A. Veicsteinas ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Body Composition ◽  
Body Composition Assessment ◽  
Cord Injury
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