Energy Imbalance

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To maintain a healthy weight, one must stay in energy balance whereby energy intake equals energy expenditure. Total daily energy expenditure is determined by three factors: resting metabolic rate, physical activity and the thermic effect of food. In addition to lifestyle practices (e.g., smoking) each of these factors is altered following a SCI, rendering it challenging for patients to achieve and maintain energy balance (De Groot et al. 2008). The resting metabolic rate of people with chronic SCI is estimated to be 14-27% lower than their non-SCI counterparts, largely due to reductions in fat-free mass and reduced sympathetic nervous system activity (Buchholz & Pencharz 2004). Physical activity levels of persons with SCI are generally lower than that of non-SCI persons (Buchholz & Pencharz 2004). In addition, a lower thermic effect of food has been reported in persons with a SCI compared to non-SCI controls (Monroe et al. 1998). Three studies have examined dietary intake and malnutrition in the SCI population (Pellicane et al. 2013; Sabour et al. 2012; Wong et al. 2012).

Table 1: Dietary Intake in Individuals with SCI


Pellicane et al. (2013) found that among four populations (i.e., SCI, stroke, traumatic brain injury, and Parkinson’s disease), mean caloric intake, but not protein intake, was significantly higher in the SCI population compared to the others (p=0.004). Both Pellicane et al. (2013) and Sabour et al. (2012) reported that ageand gender significant predictor of calorie and protein intake. Further, Sabour et al. (2012) found that simple carbohydrate consumption was excessive among their sample. There were no differences in calorie intake between those with tetraplegia versus paraplegia. Excessive or limited dietary intake can leave individuals at risk for nutritional malnourishment. Wong et al. (2012) examined rates of malnourishment among individuals with SCI on admission to hospital. The authors reported that 40.0% of the sample were found to be nutritionally ‘at risk’ and 21.4% were assessed as being ‘at high risk’ of malnutrition. Thus, there are a significant number of individuals at risk of developing further nutrition-related complications post SCI.

Given alterations in resting energy expenditure, it can be challenging to accurately estimate daily energy requirements for individuals with post-acute SCI. Equations validated and used in non-SCI populations to predict resting metabolic rate overestimate actual measured energy needs in the SCI population (Buchholz & Pencharz 2004). Therefore, it has been suggested that energy needs following SCI are best assessed by indirect calorimetry using a metabolic cart (Hadley 2002). Because not all health care centers have access to metabolic carts to measure resting metabolic rate, validated equations specific to the SCI population are needed.


There is level 5 evidence (from two observational studies; Pellicane et al. 2013; Sabour et al. 2012) that age and gender, but not level of injury, predict total caloric intake in individuals with SCI.

There is level 5 evidence (from one observational study; Wong et al. 2012) that individuals with SCI are at a significant risk for malnourishment.

  • Age and gender, but not level of injury, predict total caloric intake in individuals with SCI.

    Individuals with SCI are at a significant risk for malnourishment.