Ann Rehabil Med.  2022 Feb;46(1):24-32. 10.5535/arm.21144.

Factors Affecting Metabolic Syndrome in Individuals With Chronic Spinal Cord Injury

• Shin JW
• Kim T
• Lee BS
• Kim O

• KMID: 2527096
• DOI: http://doi.org/10.5535/arm.21144

Abstract

Objective
To assess the validity of different anthropometric measures (waist circumference [WC], body mass index [BMI], and percentage body fat) in diagnosing metabolic syndrome (MetS) among individuals with SCI and provides preliminary data for future studies in setting obesity cutoff values for this population.
Methods
This was a single-center retrospective cohort study. Sample information, anthropometric measures, and MetS variables of 157 individuals with chronic SCI were collected from an electronic medical records database.
Results
Increasing age (odds ratio [OR]=1.040, p=0.016) and lower neurological level of injury (OR=1.059, p=0.046) were risk factors for MetS. Male BMI (r=0.380, p<0.001) and male WC (r=0.346, p<0.001) were positively correlated with the number of MetS subfactors. Individuals with non-obese WC, excluding central obesity, were associated with having no MetS subfactors (p=0.005), and individuals with obese WC were associated with one or more subfactors (p=0.005). BMI was associated with MetS diagnosis (area under the curve=0.765, p<0.001), with the calculated cutoff value for BMI being 22.8 kg/m².
Conclusion
This study calls for a stricter BMI cutoff for individuals with SCI in diagnosing MetS and warrants a large population-based study to define central obesity according to sex and ethnicity.

Keyword

Spinal cord injuries; Metabolic syndrome; Obesity

Reference

1. Garshick E, Kelley A, Cohen SA, Garrison A, Tun CG, Gagnon D, et al. A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord. 2005; 43:408–16.

2. Torpy JM, Lynm C, Glass RM. The metabolic syndrome. JAMA. 2006; 295:850.

3. Chen YM, Ho SC, Lam SS, Chan SS. Validity of body mass index and waist circumference in the classification of obesity as compared to percent body fat in Chinese middle-aged women. Int J Obes (Lond). 2006; 30:918–25.

4. Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006; 444:881–7.

5. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003; 289:76–9.

6. Stefan N, Kantartzis K, Machann J, Schick F, Thamer C, Rittig K, et al. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008; 168:1609–16.

7. Despres JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, Bouchard C. Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis. 1990; 10:497–511.

8. Despres JP. Is visceral obesity the cause of the metabolic syndrome? Ann Med. 2006; 38:52–63.

9. Engin A. The definition and prevalence of obesity and metabolic syndrome. Adv Exp Med Biol. 2017; 960:1–17.

10. Maruyama Y, Mizuguchi M, Yaginuma T, Kusaka M, Yoshida H, Yokoyama K, et al. Serum leptin, abdominal obesity and the metabolic syndrome in individuals with chronic spinal cord injury. Spinal Cord. 2008; 46:494–9.

11. Edwards LA, Bugaresti JM, Buchholz AC. Visceral adipose tissue and the ratio of visceral to subcutaneous adipose tissue are greater in adults with than in those without spinal cord injury, despite matching waist circumferences. Am J Clin Nutr. 2008; 87:600–7.

12. Sumrell RM, Nightingale TE, McCauley LS, Gorgey AS. Anthropometric cutoffs and associations with visceral adiposity and metabolic biomarkers after spinal cord injury. PLoS One. 2018; 13:e0203049.

13. Ravensbergen HR, Lear SA, Claydon VE. Waist circumference is the best index for obesity-related cardiovascular disease risk in individuals with spinal cord injury. J Neurotrauma. 2014; 31:292–300.

14. Inayama T, Higuchi Y, Tsunoda N, Uchiyama H, Sakuma H. Associations between abdominal visceral fat and surrogate measures of obesity in Japanese men with spinal cord injury. Spinal Cord. 2014; 52:836–41.

15. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract. 2007; 75:72–80.

16. World Health Organization. International perspectives on spinal cord injury [Internet]. Geneva, Switzerland: World Health Organization;2013. [cited 2022 Jan 20]. Available from: https://apps.who.int/iris/handle/10665/94190.

17. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112:2735–52.

18. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143–421.

19. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001; 285:2486–97.

20. Ma WY, Li HY, Hung CS, Lin MS, Chiu FC, Lin CH, et al. Metabolic syndrome defined by IDF and AHA/NHLBI correlates better to carotid intima-media thickness than that defined by NCEP ATP III and WHO. Diabetes Res Clin Pract. 2009; 85:335–41.

21. Eastwood EA, Hagglund KJ, Ragnarsson KT, Gordon WA, Marino RJ. Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury: 1990-1997. Arch Phys Med Rehabil. 1999; 80:1457–63.

22. Afsar SI, Sarifakioglu B, Yalbuzdag SA, Saracgil Cosar SN. An unresolved relationship: the relationship between lesion severity and neurogenic bladder in patients with spinal cord injury. J Spinal Cord Med. 2016; 39:93–8.

23. Skilton MR, Moulin P, Serusclat A, Nony P, Bonnet F. A comparison of the NCEP-ATPIII, IDF and AHA/NHLBI metabolic syndrome definitions with relation to early carotid atherosclerosis in subjects with hypercholesterolemia or at risk of CVD: evidence for sex-specific differences. Atherosclerosis. 2007; 190:416–22.

24. Yahiro AM, Wingo BC, Kunwor S, Parton J, Ellis AC. Classification of obesity, cardiometabolic risk, and metabolic syndrome in adults with spinal cord injury. J Spinal Cord Med. 2020; 43:485–96.

25. Hirode G, Wong RJ. Trends in the prevalence of metabolic syndrome in the United States, 2011-2016. JAMA. 2020; 323:2526–8.

26. Gater DR Jr, Farkas GJ, Berg AS, Castillo C. Prevalence of metabolic syndrome in veterans with spinal cord injury. J Spinal Cord Med. 2019; 42:86–93.

27. Examination Committee of Criteria for ‘Obesity Disease’ in Japan; Japan Society for the Study of Obesity. New criteria for ‘obesity disease’ in Japan. Circ J. 2002; 66:987–92.

28. Anuurad E, Shiwaku K, Nogi A, Kitajima K, Enkhmaa B, Shimono K, et al. The new BMI criteria for asians by the regional office for the western pacific region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers. J Occup Health. 2003; 45:335–43.

29. Bluvshtein V, Korczyn AD, Pinhas I, Vered Y, Gelernter I, Catz A. Insulin resistance in tetraplegia but not in mid-thoracic paraplegia: is the mid-thoracic spinal cord involved in glucose regulation? Spinal Cord. 2011; 49:648–52.

30. Gater DR Jr. Obesity after spinal cord injury. Phys Med Rehabil Clin N Am. 2007; 18:333–51.

31. Gupta N, White KT, Sandford PR. Body mass index in spinal cord injury: a retrospective study. Spinal Cord. 2006; 44:92–4.

32. Weaver FM, Collins EG, Kurichi J, Miskevics S, Smith B, Rajan S, et al. Prevalence of obesity and high blood pressure in veterans with spinal cord injuries and disorders: a retrospective review. Am J Phys Med Rehabil. 2007; 86:22–9.

33. Krassioukov A, Claydon VE. The clinical problems in cardiovascular control following spinal cord injury: an overview. Prog Brain Res. 2006; 152:223–9.

34. Myers J, Lee M, Kiratli J. Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management. Am J Phys Med Rehabil. 2007; 86:142–52.

35. Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008; 359:2105–20.

36. Cerhan JR, Moore SC, Jacobs EJ, Kitahara CM, Rosenberg PS, Adami HO, et al. A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin Proc. 2014; 89:335–45.

37. Song X, Jousilahti P, Stehouwer CD, Soderberg S, Onat A, Laatikainen T, et al. Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations. Eur J Clin Nutr. 2013; 67:1298–302.

38. Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of followup in US women. Circulation. 2008; 117:1658–67.

39. Laughton GE, Buchholz AC, Martin Ginis KA, Goy RE; SHAPE SCI Research Group. Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord. 2009; 47:757–62.

40. Coppini LZ, Waitzberg DL, Campos AC. Limitations and validation of bioelectrical impedance analysis in morbidly obese patients. Curr Opin Clin Nutr Metab Care. 2005; 8:329–32.