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Nutrition in acute and chronic diseases

A longitudinal analysis of resting energy expenditure and body composition in people with spinal cord injury undergoing surgical repair of pressure injuries: a pilot study

Abstract

Background

Data informing energy needs of people with spinal cord injury (SCI) and pressure injuries are scarce, the impact of surgical repair unknown, and the role of body composition in healing unexplored. The study aims were to investigate resting energy expenditure (REE) over the course of pressure injury surgical repair, compare with available energy prediction equations, and explore associations between body composition and wound healing.

Methods

Indirect calorimetry measured REE pre-surgery, post-surgery, at suture removal and hospital discharge. A clinically significant change was defined as +/−10% difference from pre-surgery. Eight SCI-specific energy prediction equations were compared to pre-surgery REE. Wound breakdown (Yes/No), weight, waist circumference (WC), and body composition (fat mass [FM], fat-free mass [FFM], bioimpedance spectroscopy) were measured.

Results

Twenty people underwent pressure injury surgical repair (95% male, mean age 56 ± 12 years, 70% paraplegia). Between pre-surgery and discharge, mean REE increased (+118 kcal/d, p = 0.005), but with <10% change at any timepoint. An energy prediction equation incorporating FFM showed greatest agreement (rc = 0.779, 95% CI: 0.437, 0.924). Those with wound breakdown (65%) had a higher weight (12.7 kg, 95% CI: −4.0, 29.3), WC (17.8 cm, 95% CI: −5.1, 40.7), and FM % (36.0% [IQR 31.8, 40.2] vs 26.0% [IQR 15.6, 41.3]) than those without wound breakdown, although statistical significance was not reached.

Conclusion

The presence of pressure injuries and subsequent surgical repair did not impact REE and energy prediction equations incorporating FFM performed best. While not statistically significant, clinically important differences in body composition were observed in those with wound breakdown.

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Fig. 1: Resting energy expenditure (REE) from pre-surgery until hospital discharge (n = 18, mean ± SD).

Data availability

Deidentified data described in the manuscript will be made available upon request pending local ethical approval.

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Acknowledgements

The authors acknowledge the statistical support received through the Metro South Health Biostatistics Service and Professor Jeff Coombes from the University of Queensland.

Funding

This research study received funding from the Hopkins Centre - Research for Rehabilitation and Resilience and the Metro South Research Support Scheme.

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Authors and Affiliations

Authors

Contributions

AN and IH conceived the project and developed the research plan. SU, SA, TG, LW, AV and EW provided oversight and feedback on all aspects of the research. AN conducted the research. IH and LW provided essential materials and technical assistance (indirect calorimetry and bioimpedance spectroscopy). AN, EGR and LW designed and performed statistical analysis. AN wrote the paper and had primary responsibility for final content. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Amy N. Nevin.

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Competing interests

Author LCW provides consultancy services to ImpediMed Ltd; all other authors declare no competing interests.

Ethical approval

This study was approved by the Metro South Human Research Ethics Committee (HREC/13/QPAH/305).

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Nevin, A.N., Urquhart, S., Atresh, S.S. et al. A longitudinal analysis of resting energy expenditure and body composition in people with spinal cord injury undergoing surgical repair of pressure injuries: a pilot study. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-022-01248-6

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