title: Carbohydrate and lipid disorders and relevant considerations in persons with spinal cord injury.
abstract: OBJECTIVE
  To assess the prevalence of carbohydrate and lipid disorders in adults with chronic spinal cord injury and evaluate their risk contribution to cardiovascular diseases and the potential impact of exercise and pharmacologic and dietary therapies to alter these disorders and reduce cardiovascular disease risk.
  
  
  METHODS
  MEDLINE (PubMed), Cochrane Database and Web sites of the American Spinal Injury Association, American Paraplegia Society, Paralyzed Veterans of America, Consortium of Spinal Cord Medicine, and WorldCat through August 2007.
  
  
  METHODS
  English language observational studies addressing prevalence of carbohydrate and lipid disorders were included if they evaluated at least 100 adults with chronic spinal cord injury or a total of 100 subjects if using a control group. Epidemiologic investigations of more than 50 adults with spinal cord injury that were published in English after 1990 and reported cardiovascular morbidity and mortality were abstracted. Intervention studies from 1996-2007 were included regardless of design or size if they assessed exercise, diet, or pharmacologic therapies and reported carbohydrate, lipid, or cardiovascular outcomes.
  
  
  RESULTS
  The quality of evidence regarding the prevalence, impact, and outcomes of carbohydrate and lipid disorders in adults with chronic spinal cord injuries is weak. Evidence is limited by relatively few studies, small sample size, lack of appropriate control groups, failure to adjust for known confounding variables, and variation in reported outcomes. However, the existing evidence does not indicate that adults with spinal cord injuries are at markedly greater risk for carbohydrate and lipid disorders or subsequent cardiovascular morbidity and mortality than able-bodied adults. Body mass index is not reliable for assessing body composition, especially percent body fat, in adults with spinal cord injury. There are no high quality studies evaluating the impact of exercise, diet, or pharmacologic therapies on these disorders.
  
  
  CONCLUSIONS
  The available evidence does not support incorporating SCI status as an independent variable to assess risk of cardiovascular morbidity and mortality or to alter diagnostic/treatment thresholds compared to able-bodied adults. Furthermore, individuals with SCI may have unique physiologic differences compared to able-bodied individuals. As a result, it is uncertain that findings from studies conducted in able-bodied adults evaluating efficacy and harms of interventions to improve carbohydrate, lipid disorders, and subsequent CVD can be extrapolated to individuals with SCI. The role of exercise in individuals with spinal cord injuries represents a unique challenge and requires further exploration into the benefits, harms, and resource implications of broad-based spinal cord injury exercise programs.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilt
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Carlson
authors.forename: Gary D
authors.initials: GD
authors.lastname: Goldish
authors.forename: Roderick
authors.initials: R
authors.lastname: MacDonald
authors.forename: Catherine
authors.initials: C
authors.lastname: Niewoehner
authors.forename: Indulis
authors.initials: I
authors.lastname: Rutks
authors.forename: Tatyana
authors.initials: T
authors.lastname: Shamliyan
authors.forename: James
authors.initials: J
authors.lastname: Tacklind
authors.forename: Brent C
authors.initials: BC
authors.lastname: Taylor
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
mesh_terms: D000328:Adult; D000368:Aged; D050260:Carbohydrate Metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D044882:Glucose Metabolism Disorders / Q000209:etiology / Q000628:therapy; D006801:Humans; D052439:Lipid Metabolism Disorders / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000378:metabolism / Q000401:mortality