5 research outputs found
The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury
Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as “silent killers”, cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health
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Energy expenditure and nutrient intake after spinal cord injury: a comprehensive review and practical recommendations
Abstract Many persons with spinal cord injury (SCI) have one or more preventable chronic diseases related to excessive energetic intake and poor eating patterns. Appropriate nutrient consumption relative to need becomes a concern despite authoritative dietary recommendations from around the world. These recommendations were developed for the non-disabled population and do not account for the injury-induced changes in body composition, hypometabolic rate, hormonal dysregulation and nutrition status after SCI. Because evidence-based dietary reference intake values for SCI do not exist, ensuring appropriate consumption of macronutrient and micronutrients for their energy requirements becomes a challenge. In this compressive review, we briefly evaluate aspects of energy balance and appetite control relative to SCI. We report on the evidence regarding energy expenditure, nutrient intake and their relationship after SCI. We compare these data with several established nutritional guidelines from American Heart Association, Australian Dietary Guidelines, Dietary Guidelines for Americans, Institute of Medicine Dietary Reference Intake, Public Health England Government Dietary Recommendations, WHO Healthy Diet and the Paralyzed Veterans of America (PVA) Clinical Practice Guidelines. We also provide practical assessment and nutritional recommendations to facilitate a healthy dietary pattern after SCI. Because of a lack of strong SCI research, there are currently limited dietary recommendations outside of the PVA guidelines that capture the unique nutrient needs after SCI. Future multicentre clinical trials are needed to develop comprehensive, evidence-based dietary reference values specific for persons with SCI across the care continuum that rely on accurate, individual assessment of energy need
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C48 RESUSCITATION: INCREASING BENEFIT AND DECREASING HARM: The Impact Of Implementing A Rapid Response And Code Blue Team In An Academic Tertiary Care Hospital With A Hybrid Medical Staff
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B47 CRITICAL CARE: CLINICAL RESEARCH DISCOVERIES, EPIDEMIOLOGY, AND HEALTH SERVICES FOR SEPSIS: Time Is It! Before And After Standardizing The Controversial Sepsis Resuscitation Bundle In A Large Hybrid Academic Center
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Cardiac structure and function relates to body composition and metabolic profiles in high spinal cord injury
Reduced cardiovascular function is common following high spinal cord injury (SCI), yet it is unknown whether cardiac structure and function are related to SCI-induced changes in body composition and metabolic profiles. The objective of this study was to examine the correlation between cardiac structure and function and body composition and metabolic profiles after SCI.
In this IRB-approved study, participants with chronic motor complete C4-T4 SCI were included and completed informed consent. All participants underwent a dobutamine echocardiogram to assess cardiac structure and function. Dual-energy x-ray absorptiometry assessed body composition. Basal metabolic rate, respiratory quotient, and percent substrate oxidation were measured after a 12 h overnight fast using indirect calorimetry. Venipuncture was used to assess basic metabolic, lipid, and carbohydrate panels. Spearman correlations were used to evaluate relationships with an a priori alpha of 5%.
Subjects were five males and one female (age: 43.2±10.8 y, body mass index: 30.6±10.8) with SCI of 8±10.8 years duration at the C6 to the T3 levels. Left ventricle internal systolic dimension correlated with both triglycerides (ρ=-0.982, p=0.018) and very low-density lipoprotein cholesterol (VLDL; ρ=-0.982, p=0.018). Left ventricle internal diastolic dimension correlated with bone mineral content (ρ=0.953, p=0.047), high density lipoprotein cholesterol (ρ=0.956, p=0.044), low-density lipoprotein cholesterol (LDL; ρ=-0.976, p=0.024), and blood urea nitrogen (BUN; ρ=-0.975, p=0.025). Both the interventricular septum diastolic thickness and interventricular internal diastolic dimension were related to subcutaneous fat (both ρ=0.999, p=0.029). Left atrium dimension correlated with total cholesterol (TC; ρ=-0.979, p=0.021), LDL (ρ=-0.990, p=0.010), BUN (ρ=-0.958, p=0.042), and sodium (ρ=-0.962, p=0.038). Similarly, the left atrium anteroposterior dimension correlated with TC (ρ=-0.979, p=0.021), LDL (ρ=-0.990, p=0.010), BUN (ρ=-0.958, p=0.042), and sodium (ρ=-0.962, p=0.038). Aortic root diameter (ρ=1.00, p=0.004) and aortic outflow area (ρ=1.00, p=0.011) correlated with visceral fat. Functionally, maximal heart rate correlated with android mass (ρ=0.947, p=0.015), android fat (AF; ρ=0.933, p=0.021), and percent AF (ρ=0.897, p=0.039). End diastolic volume correlated with lean body mass (ρ=0.993, p=0.007), android mass (ρ=0.980, p=0.020), AF (ρ=0.980, p=0.020), percent AF (ρ=0.989, p=0.011), visceral fat (ρ=1.00, p=0.010), respiratory quotient (ρ=0.973, p=0.027), and percent fat (ρ=0.977, p=0.023) and percent carbohydrate (ρ=0.977, p=0.023) oxidation during basal metabolic rate.
Cardiac structure and function were related to body composition and metabolic profiles in high motor complete SCI.
These findings demonstrate the need to consider body composition and metabolic profile in cardiac structure and function after SCI