Article
Healthy body mass index values often underestimate body fat in men with spinal cord injury1,

https://doi.org/10.1016/S0003-9993(03)00045-5Get rights and content

Abstract

Jones LM, Legge M, Goulding A. Healthy body mass index values often underestimate body fat in men with spinal cord injury. Arch Phys Med Rehabil 2003;84:1068- 71.

Objective:

To examine the relation between body mass index (BMI) and adiposity in men with spinal cord injury (SCI).

Design:

Cross-sectional study.

Setting:

Outpatient study in 2 centers in New Zealand.

Participants:

Nineteen men with traumatic SCI were age-, height-, and weight-matched with 19 able-bodied men.

Interventions:

Not applicable.

Main Outcome Measures:

BMI (kg/m2) and dual-energy x-ray absorptiometry measures of total and regional lean tissue mass and fat mass.

Results:

Although the groups had similar BMIs, the total lean tissue mass was 8.9kg lower (95% confidence interval [CI], −12.7 to −5.2; P<.001) whereas total fat mass was 7.1kg greater (95% CI, 1.3–12.8; P<.05) in the SCI group. Body fat percentage was 9.4% (95% CI, 3.6–15.1; P<.01) greater in the SCI group. Regional measures showed a similar pattern. Truncal fat mass increased 3.7kg (95% CI, 0.5–6.9; P<.05) in the SCI group compared with controls.

Conclusions:

Body fat mass was greater for any given BMI in the SCI group. Many patients with SCI do not appear to be obese, yet they carry large amounts of fat tissue. BMI is widely used to estimate adiposity, but it may underestimate body fat in men with SCI.

Section snippets

Methods

Twenty men with SCI (age range, 16–52y) and 20 age-, height- and weight-matched able-bodied male controls participated in this study, which was approved by the Health Funding Authority, Otago and Canterbury Ethics Committees. Participants with SCI were recruited through the Burwood Spinal Unit, whereas the controls were recruited via advertisement. None of our subjects were amputees, and none of participants with SCI had heterotopic ossification or orthopedic pins in scan regions of interest.

Results

The results from 19 SCI participants and 19 controls were used in the statistical analyses. One of the 20 participants with SCI originally enrolled in our sample (a tetraplegic patient with an incomplete [ASIA class D] spinal cord lesion) was excluded because he was under 18 years of age and thus was outside of the age range for the WHO criteria for the BMI values used in this study. His matched control was also excluded from the final analysis. It is known that BMI values of healthy subjects

Discussion

Obesity is a major contributing factor in the development of both coronary heart disease and type II diabetes mellitus. BMI generally correlates well with adiposity,41 and body mass indices between 19 and 26kg/m2 show a linear correlation with body fat in healthy able-bodied men.42 The association between excessive adiposity with heart disease and type II diabetes has led to the widespread use of BMI as a simple, cost-effective measure of adiposity. Epidemiologic studies18, 19 favor use of BMI

Conclusion

We found substantially greater adiposity for similar healthy BMI values in a group of men with SCI who do not appear obese, compared with able-bodied men of similar age, height, and weight. A major purpose of this study was to raise awareness among health professionals that a healthy BMI may mask excessive adiposity in people with SCI. The sample in this study was limited in size, thus we suggest that further large-scale studies attempt to identify BMI cutoff values that may characterize

Acknowledgements

We acknowledge Brian Niven, Department of Mathematics and Statistics, University of Otago, for his assistance with our statistical analyses.

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      Other studies have described post-SCI disruption of glucose metabolism in rats and adipokine production in people, both of which can contribute to elevated cardiovascular disease in the SCI population (Farkas and Gater, 2018; Gaudet et al., 2019). Clinical studies suggest that two-thirds of individuals with chronic SCI have a greater degree of adiposity for any given BMI value, thus characterizing them as overweight or obese more frequently than the general population (Gorgey and Gater, 2011; Gupta et al., 2006; Jones et al., 2003; Spungen et al., 2003; Weaver et al., 2007). Additionally, 76% of people with SCI have dyslipidemia, while 50% of paraplegics and 62% of tetraplegics exhibit impaired glucose tolerance (Bauman and Spungen, 1994; Cragg et al., 2012; Manns et al., 2005; Nelson et al., 2007; Vichiansiri et al., 2012).

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    Supported by the Lamar Trust and Group Bone Health, Dunedin, NZ.

    1

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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