Investigating the Energy Expenditure of Acute Spinal Cord Injured Patients

Feasibility Study to Investigate the Energy Expenditure of Acute Spinal Cord Injured Patients at Different Stages of Rehabilitation

It is recognised that weight gain is a common problem in patients with a spinal cord injury and can lead to an increased incidence of metabolic syndrome. Weight gain is thought to be attributed to excess calorie intake, reduction in energy requirements and / or a reduction in exercise. However, further understanding of this energy imbalance needs to be addressed.

This feasibility study will initially determine if it is feasible to measure the 'actual' energy requirements of 15 paraplegic and 15 tetraplegic (ventilated and non-ventilated) in-patients during bed rest and rehabilitation following acute SCI. This preliminary data will be compared to 'predicted' energy expenditure levels. The calorie intake and body composition for each patient will be measured as well as factors indicative of metabolic syndrome. The study will initially provide statistical information in order to estimate the sample size required for a future definitive study.

Study Overview

• Status: Completed
• Conditions: Spinal Cord Injury, Acute
• Intervention / Treatment: Diagnostic test: GE Healthcare Metabolic Oxygenator

Detailed Description

Introduction:

There are an estimated 40,000 people living with a Spinal Cord Injury (SCI) in the UK alone (http://www.apparelyzed.com/statistics.html). Although there have been improvements in medical care, mortality rates are still elevated compared to the able-bodied population. The most common underlying and contributing causes of death in SCI patients are diseases of the circulatory and respiratory system.

It is recognised that weight gain is a common problem in patients with a SCI, typically occurring within the first year of rehabilitation and continuing life long. SCI patients have been shown to have an increased fat mass, waist circumference and altered lipid profile. Obesity in SCI patients can lead to an increased incidence of metabolic syndrome.

Patient weight gain is thought to be attributed to the reduction in energy expenditure compared to pre-injury levels, the loss of voluntary muscle use below the spinal cord lesion and reduction in lean tissue mass. It has been shown that the basal metabolic rate (BMR) of SCI patients is lower than predicted, with the greatest difference being for high tetraplegics. Findings suggest there is an overestimation of energy requirements in a small population of medically stable SCI patients. In addition, SCI calorie and protein intake is high in this patient population, suggesting that patients are also exceeding their nutritional recommendations. Excess calorie intake, reduction in energy requirement and / or a reduction in exercise will predispose the SCI patient to weight gain and obesity. Further understanding of this energy imbalance needs to be addressed.

This single centre feasibility study will initially determine if it is feasible to measure the 'actual' energy requirements of paraplegic and tetraplegic (ventilated and non-ventilated) in-patients during bed rest and rehabilitation following acute SCI. This preliminary data will be compared to 'predicted' energy expenditure levels. The calorie intake and body composition for each patient will be measured as well as factors indicative of metabolic syndrome. The study will initially provide statistical information in order to estimate the sample size required for a future definitive study on energy expenditure and development of metabolic syndrome in SCI patients. In addition, the feasibility study will address patient recruitment rates and reasons for withdrawal from the study and highlight any practicality issues with study conduct.

Recruitment:

15 acute paraplegic and 15 acute tetraplegic (ventilated and non-ventilated) inpatients will recruited.

Methodology:

The following procedures will be performed at bed rest, early mobilisation and hospital discharge:

Measurement of Actual Energy Expenditure Actual resting energy expenditure (REE) is determined by measuring the oxygen consumption and carbon dioxide production of a patient at rest using the GE Healthcare metabolic oxygenator. During the test, the individual is interfaced with a metabolic measurement system by means of a facemask. For ventilated patients, the monitor will be used with a cuffed tracheostomy tube.

Software will be used to calculate the respiratory quotient (RQ).

Calculating Predicted Energy Requirements Henry equations are used to predict the basal metabolic rate. Adjustments are made based on metabolic stress associated with illness and for obese individuals.

Determining Dietary Intake The patient's dietary intake will be reported using the standard hospital food charts. These will be completed for all food and fluids taken providing an indication of portion sizes. The charts will be kept for 3 consecutive days at each time point and is based on a pragmatic approach to improve accuracy of completion over a short period of time whilst still providing daily variations in intake. Data will be collected so that it covers at least one day of a weekend.

Anthropometric Measurements

Anthropometric measurements will be taken to determine patient body fat and muscle. The following parameters will be measured:

1. Mid Upper Arm Circumference (MUAC)
2. Tricep Skinfold Thickness (TSF)

Mid Arm Muscle Circumference (MAMC) will be calculated using the equation:

MAMC = MUAC - 3.14 x TSF

Metabolic Syndrome Measurements

The following will be measured:

1. Weight
2. Height
3. BMI Calculation
4. Blood Pressure
5. Waist Circumference
6. Fasting glucose, HDL, triglycerides

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Sheffield, United Kingdom, S5 7AU
    • Northern General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Aged 18+ years old inclusive
• Traumatic and non-traumatic tetraplegic or paraplegic patient following acute SCI injury
• First referral to the Sheffield Spinal Injuries Centre
• Pressure ulcer(s) category 1 and/or 2 or normal skin
• Be able to provide written informed consent or verbal consent in the presence of an independent witness
• Ventilated patients without sedation
• Enterally fed patients

Exclusion Criteria:

• Aged less than 18 years old
• Lack the mental capacity to consent
• Pressure ulcer(s) category 3 and/or 4
• Previously had or currently have metabolic syndrome
• Previously had or currently have diabetes
• Current medication includes either a stimulant(s) and/or depressant(s) e.g. steroids, anti-depressants
• MRSA bacterium positive
• Previously had or currently has an eating disorder
• Ventilated patients with sedation
• Currently participating in another research study which may have an impact on the study or patient safety and well-being.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: GE Healthcare Metabolic Oxygenator; The actual and predicted energy expenditure of tetraplegic (ventilated/non-vent) and paraplegic patients will be measured at three time points during the patient's rehabilitation in hospital.	Diagnostic test: GE Healthcare Metabolic Oxygenator

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sample size for definitive study	Standard deviation of Resting Energy Expenditure measurements at hospital admission, initial mobilisation and hospital discharge	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recruitment Period for Definitive Study	Number of patients recruited per year	1 year
Predicted Energy Requirements	Basal metabolic rate at hospital admission, initial mobilisation and hospital discharge	1 year
Dietary Intake	Hospital food chart analysis upon hospital admission, at initial mobilisation and hospital discharge	1 year
Muscle Measurements	Mid arm muscle circumference measured at hospital admission, initial mobilisation and hospital discharge	1 year
Adipose Tissue Measurements	Waist circumference measured at hospital admission, initial mobilisation and hospital discharge	1 year
Lipid Measurements	Fasting blood lipid profile measured at hospital admission, initial mobilisation and hospital discharge	1 year
BMI Measurements	BMI calculated from height and weight measurements at hospital admission, initial mobilisation and hospital discharge	1 year
Blood Pressure Measurements	Blood pressure measured at hospital admission, initial mobilisation and hospital discharge	1 year
Glucose Measurements	Fasting blood glucose measured at hospital admission, initial mobilisation and hospital discharge	1 year

Collaborators and Investigators

• Sponsor: Sheffield Teaching Hospitals NHS Foundation Trust
• Collaborators: University of Sheffield; Nutricia UK Ltd

Study record dates

Study Major Dates

• Study Start (Actual): August 10, 2015
• Primary Completion (Actual): October 31, 2019
• Study Completion (Actual): October 31, 2019

Study Registration Dates

• First Submitted: July 13, 2017
• First Submitted That Met QC Criteria: September 4, 2018
• First Posted (Actual): September 7, 2018

Study Record Updates

• Last Update Posted (Actual): June 9, 2022
• Last Update Submitted That Met QC Criteria: June 8, 2022
• Last Verified: June 1, 2022

More Information

Terms related to this study

• Keywords: Energy, spinal cord injury
• Additional Relevant MeSH Terms: Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Trauma, Nervous System; Spinal Cord Diseases; Spinal Cord Injuries
• Other Study ID Numbers: STH18054

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No