Trends in Measuring Basal and Resting Metabolic Rates after Spinal Cord Injury: A Comprehensive Review.

Studying factors that contribute to our understanding of maintaining normal energy balance are of paramount significance following spinal cord injury (SCI). Accurate determination of energy needs is crucial for providing nutritional guidance and managing the increasing prevalence of malnutrition or obesity after SCI. Basal metabolic rate (BMR) represents 75-80% of the total energy expenditure in persons with SCI. Accurately measuring BMR is an important component for calculating total caloric needs in this population. Indirect calorimetry is considered the gold-standard technique for measuring BMR. However, technical challenges may limit its applications in large cohort studies and alternatively rely on prediction equations. Previous work has shown that BMR changes in response to disuse and exercise in the range of 15-120%. Factors including sex, level of injury, and type of assistive devices may influence BMR after SCI. Resting metabolic rate (RMR) is erroneously used interchangeably for BMR, which may result in overestimation of caloric intake when developing nutritional plans. To address this concern, we comprehensively reviewed studies that conducted BMR (N=15) and RMR (N=22) in persons with SCI. The results indicated that RMR is 9% greater than BMR in persons with SCI. Furthermore, the SCI-specific prediction equations that incorporated measures of fat-free mass appeared to accurately predict BMR. Overall, the current findings highlighted the significance of measuring BMR as well as encouraging the research and clinical community to effectively establish countermeasures to combat obesity after SCI.