Energy Expenditure after Spinal Cord Injury

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Abstract
Caloric requirements for spinal cord patients are not well understood. Energy expenditure was measured by indirect calorimetry and compared with predicted expenditure by manipulations of the Harris-Benedict, Quebbeman, and Spanier and Shizgal equations, using actual and ideal body wt. Forty-five measurements were made on 22 spinally injured patients, who were medically stable in their early rehabilitation phase of treatment, and included quadriplegics, paraplegics, and patients with Brown-Sequard syndrome. Other nutritional parameters were also followed. Equations based on normal patients consistently overestimated energy requirements of spinally injured patients. From the time of injury, spinally injured patients appear to have a reduction in their energy needs proportional to the amount of muscle which was denervated. This decrease in caloric requirements continues throughout the rehabilitation and plateau phases. Stable, rehabilitating spinally injured patients require 23.4 kcal/kg per day. As a group, quadriplegics required 22.7 kcal/kg per day, and paraplegics 27.9 kcal/kg per day. This represents only 45-90% of the recommended calories for maintenance as calculated by any of these recognized formulae, based on normal heights, weight, age and sex, when using either current weight or ideal body weight. Spinally injured patients as a group are subjected to fluctuations in weight during treatment. Patients tended to become obese .apprx. 12 mo. after spinal cord injury on uncontrolled diets. All patients underwent an initial weight loss which was greater in the quadriplegics as a group, compared with paraplegics. On uncontrolled diets, patients gained an average of 1.7 kg/wk and this was also greater in the quadriplegics group.

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