Leisure-time physical activity and diet quality are not associated in people with chronic spinal cord injury.

STUDY DESIGN: Cross-sectional. OBJECTIVE: To determine the association between leisure-time physical activity (LTPA) and adherence to Eating Well with Canada's Food Guide (CFG) in community-dwelling adults with chronic Spinal Cord Injury (SCI). SETTING: Ontario, Canada. METHODS: Participants were recruited as part of the Study of Health and Activity in People with SCI (SHAPE-SCI). Dietary data were collected using 24-h recalls and analysed for adherence to CFG recommendations by age group and gender. LTPA was assessed using the Physical Activity Recall Assessment for Persons with SCI. Statistical analysis comprised correlations, multiple regression and χ(2). RESULTS: We studied 75 adults (n=61 M; 42.4±11.8 years; 25.5±5.2 kg m(-2)) with chronic (≥1-year post-injury) SCI. Of these, 37% of participants were inactive, 29% were low-active and 33% were high-active. Fewer than 5% of participants were 100% adherent with CFG; 85% were adherent to ≤50%. Activity level and overall adherence to CFG were not correlated (r=-0.052, P=0.666). Although there were no associations between LTPA and vegetables and fruit, grain products, milk and alternatives, or other foods (all P>0.05), high activity was associated with consuming less than the minimum number of recommended servings of meat and alternatives (φ=-0.258, P=0.026). CONCLUSION: Clinicians need to be aware of the poor diet quality, and low levels of physical activity, of people with chronic SCI. They should not assume that those who are more active consume better quality diets than those who are low active or inactive. SPONSORSHIP: Canadian Institutes of Health Research.

Dietary supplement use in the spinal cord injury population.

STUDY DESIGN: Longitudinal, non-experimental. OBJECTIVES: To determine the following: (1) prevalence of supplement use in a representative sample of the chronic spinal cord injury (SCI) population; (2) most frequently consumed supplements; and (3) characteristics of consistent supplement users. SETTING: Ontario, Canada. METHODS: A structured questionnaire was used to collect demographic information from 77 community-dwelling adults with chronic SCI (50.6% paraplegia, 81.8% male, 42.4 + or - 11.9 years, body mass index (BMI) 25.4 + or - 5.1 kg m(-2)). A standardized form was used to record dietary intake, including supplements, in the previous 24 h, at three time points (baseline, 6 months and 18 months). Logistic regression and multivariate logistic regression were used to determine which characteristic(s) was (were) associated with consistent supplement use. RESULTS: Seventy-one percent of the sample reported using supplements at least once, with 50.6% being classified as consistent supplement users (at least twice across the three time points). The top three supplements consumed were multivitamins (25%), calcium (20%) and vitamin D (16%). Supplement use status was not associated with gender, level of injury, age, education, physical activity, BMI, smoking or alcohol intake. CONCLUSIONS: Dietary supplement use was common in our sample of individuals with long-standing SCI, but no common characteristics distinguished users from non-users. We suggest that health practitioners be aware of the high dietary supplement use in this population so that they can probe for type, dose and frequency, as supplements may have an important influence on dietary assessment results.

A pilot study examining correlates of body image among women living with SCI.

STUDY DESIGN: Cross-sectional pilot study. OBJECTIVES: To explore correlates of body image among women with spinal cord injury (SCI), within the framework of Cash's cognitive behavioral model of body image. SETTING: Hamilton, Ontario, Canada. METHODS: Women with SCI (N=11, 64% with tetraplegia) reported their functional and appearance body image (Adult Body Satisfaction Questionnaire). A 3-day recall of leisure time physical activity (LTPA), three measures of body composition (that is, weight, waist circumference, body fat) and several demographic variables were assessed as potential correlates. RESULTS: Appearance satisfaction was negatively correlated with all three measures of body composition and positively correlated with years postinjury. Functional satisfaction was positively correlated with years postinjury, and negatively correlated with various LTPA variables. CONCLUSION: Functional and appearance body image may improve with time following SCI. Body composition may impact satisfaction with physical appearance for some women. The negative relationship between LTPA and functional satisfaction merits further examination, as functional dissatisfaction may motivate individuals to engage in certain types and intensities of LTPA. Correlates of body image differ between appearance and functional satisfaction. Future research should examine appearance and functional satisfaction separately among women with SCI.

Lowering body mass index cutoffs better identifies obese persons with spinal cord injury.

STUDY DESIGN: Cross-sectional, non-experimental design. OBJECTIVES: (1) Determine the sensitivity and specificity of the general population body mass index (BMI) cutoff for obesity (30 kg m(-2)) in a representative sample of persons with spinal cord injury (SCI); (2) develop a more sensitive BMI cutoff for obesity based on percentage of fat mass (%FM) and C-reactive protein (CRP). SETTING: Ontario, Canada. METHODS: A total of 77 community-dwelling adults with chronic SCI underwent anthropometric measures (%FM by bioelectrical impedance analysis, length, weight, BMI (kg m(-2))) and provided blood samples to determine CRP. Sensitivity and specificity analyses, piecewise regression, non-linear regression, and receiver-operator characteristic curves were used to determine new BMI cutoffs. RESULTS: A BMI cutoff of 30 kg m(-2) failed to identify 73.9% of obese participants vs 26.1% at a lowered cutoff of 25 kg m(-2). BMI cutoffs based on risk levels of the %FM and CRP considered together ranged from 22.1 kg m(-2)-26.5 kg m(-2). CONCLUSIONS: People with chronic SCI and BMI values >22 kg m(-2) should be considered as being at high risk for obesity and obesity-related chronic diseases. SPONSORSHIP: Canadian Institutes of Health Research.

Caregiving arrangement and nutrition: good news with some reservations.

The objective of this study was to assess the impact of caregiving arrangement on the iron and folate status of infants and toddlers reared at home or enrolled in centre-based, independent home, or licensed home care. One hundred and eighty-nine children aged 2 to 29 months were assessed 1 month prior to child care entry and at 6 months after entry into child care. Dietary (24-hour records), anthropometric (height, weight, head circumference) and biochemical (red blood cell folate, hematocrit, transferrin, and serum ferritin concentrations) methods were used to assess nutritional status. Frequency of illness was determined by a series of telephone interviews. Median intake of nutrients exceeded Canadian recommendations, regardless of care arrangement. Fifteen of 65 children had hematocrit values below age-specific cutoffs at the 6-month post-entry to child care visit. Children were frequently taken to obtain medical advice (average of 4 to 6 times during the study period) and 75% of subjects were prescribed at least one course of antibiotics. In conclusion, infants and toddlers in this study were generally well nourished, regardless of child care arrangement; however, iron status may remain an issue in this sample of infants and toddlers.

Evidence of dietary inadequacy in adults with chronic spinal cord injury.

STUDY DESIGN: Cross-sectional, observational study. OBJECTIVE: Estimate prevalence of inadequate dietary intakes in community-dwelling men and women with chronic spinal cord injury (SCI). SETTING: Ontario, Canada. METHODS: In-home interviewer administered multiple-pass 24-h recalls were collected at baseline (n=77) and at 6 months (n=68). Dietary intake (adjusted to remove intra-individual variation) was compared with the dietary reference intakes (DRIs), specifically the estimated average requirement, adequate intake (AI) and acceptable macronutrient distribution ranges (AMDR). RESULTS: Macronutrient intakes, as percentages of daily energy, for men (16% protein, 52% carbohydrate, 30% fat) and women (17% protein, 53% carbohydrate, 28% fat) were within the AMDR. Despite this, inadequate intakes for men (n=63) and women (n=14) were determined for vitamin A (92 and 57%), magnesium (89 and 71%), folate (75 and 79%), zinc (71 and 29%), vitamin C (52 and 14%), thiamine (22 and 14%), vitamin B12 (6 and 29%), riboflavin (5% men) and vitamin B6 (24% men). Mean usual intakes of fiber, vitamin D, calcium and potassium fell below the AI for men and women. In all, 53% of participants consumed a micronutrient supplement in the previous 24 h at baseline and at 6 months-specifically, calcium (29, 19%), multivitamin (26, 25%), vitamin D (22, 12%) and vitamin C (9, 6%). CONCLUSION: Our results show numerous nutrient inadequacies, relative to the DRIs, for men and women with SCI. This study has important implications for clinical dietetic practice in the SCI population.

Current coronary heart disease risk assessment tools may underestimate risk in community-dwelling persons with chronic spinal cord injury.

STUDY DESIGN: Cross-sectional, observational study. OBJECTIVES: To quantify, in adults with chronic spinal cord injury (SCI): (1) presence of metabolic syndrome versus the general North American population (GP) and (2) 10-year coronary heart disease (CHD) risk using Framingham risk scoring (FRS). SETTING: Ontario, Canada. METHODS: Fasting anthropometric and biochemical data were collected from 75 adults with chronic SCI. Metabolic syndrome was determined using four internationally recognized definitions and FRS using the most recent (2001) algorithm. RESULTS: Prevalence of metabolic syndrome was up to 5.4 times lower in SCI participants compared to GP, and FRS categorized 3.1% of participants as being at high 10-year CHD risk. However, high-sensitivity C-reactive protein (CRP) values indicated 36.7% of participants as being at high CHD risk. CONCLUSION: Current metabolic syndrome definitions and FRS may underestimate true CHD risk in people with SCI. Tools that better identify CHD risk require validation in the SCI population. CRP may be a potential factor to consider in the development of SCI-specific screening tools.

C-Reactive protein in adults with chronic spinal cord injury: increased chronic inflammation in tetraplegia vs paraplegia.

STUDY DESIGN: Cross-sectional. OBJECTIVES: In community-dwelling adults with chronic spinal cord injury (SCI), to (1) quantify C-reactive protein (CRP), a marker of inflammation and cardiovascular disease (CVD) risk; (2) determine factors associated with CRP. SETTING: Hamilton, Ontario, Canada. METHODS: We examined CVD risk factors in 69 participants. Measurements included length, weight, waist circumference, blood pressure, percent fat mass (bioelectrical impedance analysis) and fasting blood parameters (high-sensitivity CRP, lipids, insulin, glucose, insulin resistance by homeostasis model assessment (HOMA)). RESULTS: Mean CRP of the group was 3.37+/-2.86 mg-l(-1), consistent with the American Heart Association (AHA) definition of high risk of CVD. CRP was 74% higher in persons with tetraplegia (4.31+/-2.97) than those with paraplegia (2.47+/-2.47 mg l(-1), P=0.002), consistent with high CVD risk. Participants with high CRP (3.1-9.9 mg l(-1)) had greater waist circumference, BMI, percent fat mass and HOMA values than those with lower CRP (< or =3.0 mg l(-1), all P<0.05). LogCRP was independently correlated with waist circumference (r=0.612), logTriglycerides (r=0.342), logInsulin (r=0.309) and logHOMA (r=0.316, all P<0.05). Only level of lesion and waist circumference remained significantly associated with logCRP when variables with significant bivariate correlations were included in multiple regression analysis. CONCLUSION: Mean CRP values in this sample of adults with chronic SCI were consistent with the AHA classification of high CVD risk, especially those of persons with tetraplegia. Level of lesion and waist circumference are independently associated with CRP in this population.

Establishing evidence-based physical activity guidelines: methods for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI).

STUDY DESIGN: Prospective, observational cohort study. OBJECTIVES: This paper describes the rationale and methodology for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI). The study aims to (1) describe physical activity levels of people with different injury levels and completeness, (2) examine the relationship between physical activity, risk and/or presence of secondary health complications and risk of chronic disease, and (3) identify determinants of physical activity in the SCI population. SETTING: Ontario, Canada. METHODS: Seven hundred and twenty men and women who have incurred a traumatic SCI complete self-report measures of physical activity, physical activity determinants, secondary health problems and subjective well-being during a telephone interview. A representative subsample (n=81) participate in chronic disease risk factor testing for obesity, insulin resistance and coronary heart disease. Measures are taken at baseline, 6 and 18 months. CONCLUSION: SHAPE SCI will provide much-needed epidemiological information on physical activity patterns, determinants and health in people with SCI. This information will provide a foundation for the establishment of evidence-based physical activity guidelines and interventions tailored to the SCI community.

The role of conjugated linoleic acid in reducing body fat and preventing holiday weight gain.

OBJECTIVE: The incidence of obesity and overweight in the US has increased considerably during the past two decades and currently affects 65% of the adult population. Research has indicated that small, yet irreversible, gains during the holiday season contribute to increases in weight during adulthood. Conjugated linoleic acid (CLA), a naturally occurring dietary fatty acid, has been found to reduce weight gain and dramatically decrease fat mass in animals. Although research in humans has shown inconsistent results, most studies have been of insufficient duration or have utilized body composition methods that are less accurate than the currently accepted criterion. DESIGN: Randomized, double-blind, placebo-controlled study of 3.2 g/day CLA for 6 months. SUBJECTS: Forty healthy, overweight subjects (age: 18-44 years; body mass index: 25-30 kg/m(2)). MEASUREMENTS: Body composition by the four-compartment model, resting metabolic rate (RMR) by indirect calorimetry, self-reported physical activity and dietary intake, and blood chemistries were determined at baseline and after 6 months. Body weight was measured monthly during the pre-holiday season (August-October), holiday season (November-December) and post-holiday season (January-March). Adverse events were assessed monthly. RESULTS: Compared to CLA, the placebo group showed a greater rate of weight gain during the holiday season (P=0.01). Within the placebo group, holiday weight change was significantly greater compared to the pre-holiday period (August-October) (P=0.03). Six-month change in body composition was improved with CLA compared to placebo (P=0.02), and body fat was significantly reduced within the CLA group (-1.0+/-2.2 kg, P=0.05). CLA had no effect on RMR, physical activity or dietary intake. The rate of reported negative emotions decreased significantly with CLA, although there was no difference in any other category of adverse event. In comparison to the placebo, CLA did not affect insulin resistance, blood lipids and markers of liver function or markers of inflammation, with the exception of a significant decrease in a biomarker of endothelial dysfunction. CONCLUSION: CLA supplementation among overweight adults significantly reduced body fat over 6 months and prevented weight gain during the holiday season. Although no adverse effects were seen, additional studies should evaluate the effect of prolonged use of CLA.

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury.

STUDY DESIGN: Literature review. BACKGROUND: Increased fat mass and coronary heart disease (CHD) are secondary complications of chronic spinal cord injury (SCI). In able-bodied populations, body mass index (BMI, body weight (kg)/height (m(2))) is a widely used surrogate marker of obesity and predictor of CHD risk. Waist circumference, an accurate and reproducible surrogate measure of abdominal visceral adipose tissue, is also associated with CHD risk (more so than BMI) in able-bodied populations. OBJECTIVE: To review the literature on the accuracy of BMI and waist circumference as surrogate measures of obesity and CHD risk in persons with chronic SCI. SETTING: Ontario, Canada. METHODS: Literature review. RESULTS: In the SCI population, BMI is an insensitive marker of obesity, explains less of the variance in measured percent fat mass than in the able-bodied, and is inconsistently related to CHD risk factors. This may be due to potential measurement error, and to the inability of BMI to distinguish between fat and fat-free mass and to measure body fat distribution. Waist circumference has not been validated as a surrogate measure of visceral adipose tissue, however preliminary evidence supports a relationship between waist circumference and CHD risk in the SCI population. CONCLUSIONS: We recommend that SCI-specific BMI classifications be determined. We also recommend that accuracy and reliability of waist circumference as a surrogate measure of visceral adipose tissue and CHD risk be determined in men and women with long-standing paraplegia and tetraplegia.

Is resting metabolic rate different between men and women?

A low resting metabolic rate (RMR) has been proposed as a possible cause for the increased body fat commonly seen in women compared with men. Absolute RMR is higher in men, but whether RMR adjusted for lean body mass (LBM) remains higher is unresolved. The objective of the present study was to determine whether RMR adjusted for various body composition factors differed between healthy adult men and women. Thirty men years, BMI and twenty-eight women years, BMI were included in the analyses. RMR was measured by open-circuit indirect calorimetry for 60 min. Extracellular water (ECW) was measured by corrected Br(-) space and total body water (TBW) by 2H dilution. LBM was estimated as TBW/0.732. Intracellular water (ICW) was calculated as TBW-ECW, and body cell mass (BCM) as ICW/0.732. Men were heavier and had higher BMI, LBM, BCM and ECW, but less fat mass. Absolute RMR was higher in men than women v. P<0.0001). This difference became non-significant when RMR was adjusted for LBM by ANCOVA v. P=0.2191), but remained significant when adjusted for BCM v. P=0.0249). Fat mass explained a significant amount of variation in RMR in women (r(2) 0.28, P=0.0038), but not in men (r(2) 0.03, P=0.3301). The relationships between body fat and the various subcompartments of BCM and RMR require further elucidation.