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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., PhD1; Gorgey, Ashraf S., MPT, PhD, FACSM2; Dolbow, David R., DPT, PhD, RKT3; Berg, Arthur S., PhD4; Gater, David R., MD, PhD, MS5

American Journal of Physical Medicine & Rehabilitation: February 26, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001166
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Objectives Evaluate the influence of level of spinal cord injury (SCI) on caloric intake relative to total daily energy expenditure (TDEE) and body composition (BC), and 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 (BMR), and TDEE were obtained using dietary recall, indirect calorimetry, and prediction equations, respectively. Caloric intake and TDEE were adjusted to bodyweight. BC 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 BMR (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.

Conclusion A dichotomy exists in caloric intake, TDEE, and BC among TETRA and PARA. The SCI-specific correction factor of 1.15 is a promising tool to estimate TDEE in SCI.

1Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1400 Owens, Suite 400, San Francisco, California, 94158

2Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard; Richmond, Virginia, 23249

3Department of Physical Therapy, William Carey University, 710 William Carey Pkwy, Hattiesburg, MS 39401

4Department of Public Health Sciences, Penn State College of Medicine; 500 University Drive, Hershey, Pennsylvania, 17033

5Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, 500 University Drive, Hershey, Pennsylvania, 17033

Corresponding author: Gary J. Farkas, PhD. Email: gary.farkas@ucsf.edu

Conflict of interest: The authors certify that they have no financial or other conflicts of interest.

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

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