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Caloric Intake Relative to Total Daily Energy Expenditure Using a Spinal Cord Injury–Specific Correction Factor

An Analysis by Level of Injury

Farkas, Gary J. PhD; Gorgey, Ashraf S. MPT, PhD, FACSM; Dolbow, David R. DPT, PhD, RKT; Berg, Arthur S. PhD; Gater, David R. MD, PhD, MS

American Journal of Physical Medicine & Rehabilitation: November 2019 - Volume 98 - Issue 11 - p 947–952
doi: 10.1097/PHM.0000000000001166
Original Research Articles: CME Article . 2019 Series . Number 11

Objective The aims of the study were to evaluate the influence of level of spinal cord injury (SCI) on caloric intake relative to total daily energy expenditure (TDEE) and body composition, and to develop a SCI–specific correction factor for the TDEE estimation.

Design Individuals with paraplegia (PARA, n = 28) and tetraplegia (TETRA, n = 13) were analyzed. Daily caloric intake, basal metabolic rate, and TDEE were obtained using dietary recall, indirect calorimetry, and prediction equations, respectively. Caloric intake and TDEE were adjusted to bodyweight. Body composition was assessed using dual-energy x-ray absorptiometry.

Results Total caloric (PARA 1516.4 ± 548.4, TETRA 1619.1 ± 564.3 kcal/d), fat (PARA 58.6 ± 27.4, TETRA 65.8 ± 29.7 g), and protein (PARA 62.7 ± 23.2, TETRA 71.5 ± 30.9 g) intake were significantly higher in TETRA versus PARA (P < 0.05) when adjusted for bodyweight. Adjusted and unadjusted TDEE (unadjusted: PARA 1851.0 ± 405.3, TETRA 1530.4 ± 640.4 kcal/d) and basal metabolic rate (unadjusted: PARA 1516.6 ± 398.0, TETRA 1223.6 ± 390.2 kcal/d) were significantly higher in PARA versus TETRA (P < 0.05). Bone mineral content (PARA 3.17 ± 0.6, TETRA 2.71 ± 0.5 g), lean body mass (PARA 50.0 ± 8.6, TETRA 40.96 ± 8.8 kg), and regional percent body fat (PARA 36.45 ± 8.0, TETRA 41.82 ± 9.1) were different between groups (P < 0.05). The SCI–specific correction factor was 1.15.

Conclusions A dichotomy exists in caloric intake, TDEE, and body composition among TETRA and PARA. The SCI–specific correction factor of 1.15 is a promising tool to estimate TDEE in SCI.

To Claim CME Credits Complete the self-assessment activity and evaluation online at

CME Objectives Upon completion of this article, the reader should be able to: (1) Understand the influence of spinal cord level of injury on energy expenditure and body composition; (2) Appreciate that equations used to estimate total daily energy expenditure overestimate energy expenditure in individuals with spinal cord injury; and (3) Understand the importance of normalizing caloric intake to bodyweight after spinal cord injury.

Level Advanced.

Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California (GJF); Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia (ASG); Department of Physical Therapy, William Carey University, Hattiesburg, Mississippi (DRD); Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania (ASB); and Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania (DRG).

All correspondence should be addressed to: Gary J. Farkas, PhD, Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1400 Owens, Suite 400, San Francisco, CA 94158.

This work was supported by the Veterans Health Administration (RR&D B6757R) and the National Institutes of Health (UL1RR031990).

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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Online date: February 26, 2019

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