Energy balance components in persons with paraplegia: daily variation and appropriate measurement duration

Abstract

Background: Despite obesity being highly prevalent in persons with spinal cord injury (SCI), our current understanding of the interactions between energy balance components, which may contribute to this, is limited. The primary aim of this study is to identify the intra-individual variability of physical activity dimensions across days and suggest an appropriate monitoring time frame for these constructs in adults with SCI. The secondary aim is to examine these parameters with regard to energy intake and dietary macronutrient composition.

Methods: Participants [33 men and women with chronic (> 1 year post injury) paraplegia; age = 44 ± 9 years (mean ± S.D.] wore an Actiheart™ PA monitor and completed a weighed food diary for 7 consecutive days. Spearman-Brown Prophecy Formulae, based on Intraclass Correlations of .80 (acceptable reliability), were used to predict the number of days required to measure energy balance components. Linear mixed-effects analyses and magnitude-based inferences were performed for all energy intake, expenditure and physical activity dimensions. Adjustments were made for age, injury level, wear time, sex, day of the week and measurement order as fixed effects.

Results: To reliably measure energy expenditure components; 1 day [total energy expenditure (TEE)], 2 days [physical activity energy expenditure (PAEE), light-intensity activity, moderate-to-vigorous PA (MVPA)], 3 days [physical activity level (PAL)] and 4 days (sedentary behaviour) are necessary. Device wear time (P < 0.02), injury level (P < 0.04) and sex (P < 0.001) were covariates for energy expenditure components. Four and ≤24 days are required to reliably measure total energy intake (kcal) and diet macronutrient composition (%), respectively. Measurement order (from day 1-7) was a covariate for total energy intake (P = 0.01).

Conclusions: This is the first study to demonstrate the variability of energy intake and expenditure components in free-living persons with chronic (> 1 year) paraplegia and propose suitable measurement durations to achieve acceptable reliability in outcome measures. Device wear time and measurement order play a role in the quality of energy expenditure and intake data, respectively, and should be considered when designing and analysing studies of energy balance components in persons with SCI.

Trial registration: N/A.

Keywords: Assessment; Diet; Energy balance; Energy expenditure; Energy intake; Intra-individual variance; Measurement; Paraplegia; Physical activty; Spinal cord injury.

Fig. 1

Number of monitoring days necessary to achieve acceptable reliability (ICC > 0.80) in various energy expenditure (a) and intake (b) variables. ICC, intra-class correlation; MVPA, moderate-to-vigorous physical activity; PAEE, activity energy expenditure; PAL, physical activity level; TEE, total energy expenditure

Fig. 2

Components of energy balance under free-living conditions in individuals with chronic paraplegia. Values are means ± SEs (percentage that each component contributes to total daily energy intake and expenditure). CHO: carbohydrate, DIT: Diet-induced thermogenesis, EtOH: alcohol, PAEE: physical activity energy expenditure, PRO: protein, RMR: resting metabolic rate