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Cover of Carbohydrate and Lipid Disorders and Relevant Considerations in Persons with Spinal Cord Injury

Carbohydrate and Lipid Disorders and Relevant Considerations in Persons with Spinal Cord Injury

Evidence Reports/Technology Assessments, No. 163

Investigators: , MD, MPH, , PhD, , MD, , MS, , MD, , BS, , MD, MS, , BS, , PhD, and , MD.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 08-E005

Structured Abstract

Objectives:

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.

Data Sources:

MEDLINE® (PubMed®), Cochrane Database and websites of the American Spinal Injury Association, American Paraplegia Society, Paralyzed Veterans of America, Consortium of Spinal Cord Medicine, and WorldCat through August 2007.

Review 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:

Evidence does not support using different thresholds to define or treat abnormal lipid and carbohydrate measures or to incorporate other markers to assess risk (e.g., insulin resistance, impaired fasting glucose, or impaired glucose tolerance) for individuals with spinal cord injuries compared to able-bodied adults. Due to physiologic differences between adults with spinal cord injuries and able-bodied individuals, caution may be required when extrapolating findings from studies conducted in able-bodied adults. 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.

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0009, Task Order #1. Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, Minnesota.

Suggested citation:

Wilt TJ, Carlson FK, Goldish GD, et al. Carbohydrate & Lipid Disorders & Relevant Considerations in Persons with Spinal Cord Injury. Evidence Report/Technology Assessment No. 163 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 08-E005. Rockville, MD. Agency for Healthcare Research and Quality. January 2008.

This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0009, Task Order #1). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.

1

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Bookshelf ID: NBK38458
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