Energy Expenditure Following Spinal Cord Injury: A Delicate Balance

Abstract

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.

Keywords: caloric intake; energy expenditure; metabolic rate; neurogenic obesity; spinal cord injury.

Conflict of interest statement

Conflicts of Interest The authors declare no conflicts of interest.

© 2021 American Spinal Injury Association.

Figures

Figure 1.

The relationship between energy expenditure and energy intake, and the components that influence them after spinal cord injury. TEPA, thermic effect of physical activity.