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Positive and negative energy surpluses in persons with chronic spinal cord injury
Published online by Cambridge University Press: 26 December 2025
Abstract
Total energy expenditure (TEE) is estimated as the product of BMR and a spinal cord injury (SCI)-specific factor. The agreement between TEE and total energy intake (TEI) was just established. The findings suggested the existence of positive and negative energy balance distributions. Forty-two males with chronic SCI underwent BMR followed by a detailed metabolic profile after an overnight fast. TEI and macronutrients of 3-d dietary logs were analysed using the Nutrition Data System for Research software. Energy surplus was calculated as TEE minus TEI. Body composition assessment was conducted using dual-energy X-ray absorptiometry. 57 % of SCI participants were classified as negative energy surplus with an average TEI of 1284 (sd 422) compared with 2197 (sd 553) kcal/d in the positive energy group (P = 0·0002). Negative energy group had a higher BMR (9 %; P = 0·02), greater body weight (P = 0·03) and greater total body lean mass (P = 0·03) and consumed a greater percentage of protein compared with the positive energy group. Percentage macronutrients of protein explained 27 % of the variance of energy surplus in a multivariate regression model (r2 0·27; P = 0·008). TEI adjusted to fat-free mass explained 87 % of the variance in energy surplus, and an intake of 34·7 kcal/kg per d was recommended to balance TEI with TEE. Persons with SCI are either classified into negative or positive energy surplus groups. Larger body weight and greater protein intakes are among the major characteristics of the negative energy group. Clinicians may need to consider the spectrum of energy balance before starting a dietary regimen after SCI.
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- © The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society
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