Ruheumsatz und Zusammenhang mit dem Ernährungs- und Bewegungsverhalten beiQuerschnittgelähmten

Abstract

Die vorliegende Arbeit ist daher die erste Studie zum Thema Energiebedarf bei QSL in Deutschland. Sie untersucht, ob auch hier Querschnittgelähmte einen geringeren Ruheenergieverbrauch als vergleichbare Probanden (gleiches Alter, Geschlecht, Größe etc.) einer Kontrollgruppe von Nichtgelähmten haben. Dabei soll auch das Ausmaß eines evtl. reduzierten Ruheumsatzes und die Abhängigkeit von Lähmungshöhe, Restfunktionen und körperlicher, vor allem sportlicher Aktivität erfasst werden. Außerdem sollen grundsätzliche Aspekte des Ernährungsverhaltens Querschnittgelähmter mit dem Nichtgelähmter verglichen werden. So soll festgestellt werden, ob und wenn möglich auch warum es wesentliche Unterschiede gibt, und ob diese Verhaltensunterschiede einen messbaren Einfluss auf den Energieverbrauch haben. Auch andere Einflüsse wie Bildungsniveau und insbesondere das Ernährungswissen sollen berücksichtigt werden.

Background and objectives: In several US-American studies it was stated that BMI underestimates body adiposity in people with spinal cord injury (SCI), as the massive reduction of muscles in spinally injured persons is not considered. Current equations to predict resting energy expenditure (REE) cannot be transferred to them either and there was actually found a high prevalence of overweight and obesity in this demographic. The purpose of this study was to determine REE of people with SCI, to compare it with that of able-bodied subjects and to identify parameters which might determine REE within the SCI group. Methods: 40 subjects with SCI age 21 to 65 years with complete and incomplete lesions were predominantly recruited from regular patients in a specialty clinic. Forty able-bodied subjects, predominantly employees in this clinic, age 18 to 67 years served as controls (CTRL). All participants had their REE measured by indirect calorimetry. Aspects of nutrition and exercise behaviour were obtained via questionnaire. Results: The REE in the SCI group was significantly lower than in the CTRL group (unless there was above-average physical activity). With a probability of 95% it is 13% to 21% below the REE of able-bodied. Significant qualitative differences in nutrition behaviour and general knowledge about nutrition between both groups were not found. Knowledge, however, about special aspects of post injury nutrition, was very poor in the SCI group and a high percentage got weight problems post injury. Influences of height and completeness of lesions on REE within the SCI group were not determined whereas these parameters can hardly be regarded isolated. Between physical activity and REE a significant positive correlation was found in the SCI group, but not in the CTRL group. Conclusions: As REE is, for the most part, significantly lower in spinally injured people than in those able-bodied and as the majority of the spinally injured persons are less aware of their reduced energy needs, weight problems are inevitable within this group. To identify overweight and obesity early enough to hinder comorbid conditions it is necessary to adjust BMI categories to the SCI population. Individual series of measurements of REE post injury, during rehabilitation and the obligatory regular urological checkups might provide information about the actual requirements and contribute to a healthy eating behaviour and thus keeping them from becoming overweight. Furthermore adequate information about post injury energy requirement as well as the opportunities to increase REE through physical activity should be given. It is important to support spinally injured people in participating in sustained exercise, since they are often restricted in their normal everyday activities and therefore lead a more sedentary lifestyle.