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Theme: Central Nervous System
David Gater, Jr., MD PhD MS
Professor, Chair and SCI Fellowship Program Director
University of Miami Miller School of Medicine Department of PM&R
Miami, Florida
Disclosed no relevant financial relationships.
.jpeg.jpg "Gary Farkas, PhD photo")
Gary Farkas, PhD
Postdoctoral Fellow
U Miami Miller School of Medicine
Miami, Florida
Disclosed no relevant financial relationships.
Alicia Sneij, PhD, RDN
U Miami Miller School of Medicine
Miami, Florida
Disclosed no relevant financial relationships.
The purpose of this presentation is to define neurogenic obesity and to describe the state-of-the-science regarding pathophysiology, consequences,and potential interventions for persons with spinal cord injury (SCI). Neurogenic obesity, characterized by excess adipose tissue (AT) after SCI, occurs due to an obligatory sarcopenia, neurogenic osteoporosis, neurogenic anabolic deficiency, sympathetic dysfunction, and blunted satiety. These physiological changes alter energy balance such that energy intake exceeds energy expenditure, and AT accumulates subcutaneously (SAT) and around the abdominal viscera (VAT). As the body composition changes from dense muscle and bone tissue to accumulated AT, body weight may remain the same or even decrease, leading clinicians to likely underestimate obesity if only considering body weight. Body composition assessment for SCI is a relatively expensive, labor-intensive process and recent regression equations have been provided to ease the assessment burden and estimate the percentage of AT relative to lean mass. AT drives the metabolic syndrome by secreting pro-inflammatory cytokines and other adipokines that facilitate systemic vascular inflammation, impair insulin sensitivity, mediate hypertension and promote dyslipidemia. Additional comorbidities associated with neurogenic obesity will also be discussed including upper extremity overuse, nociceptive pain, neuropathic pain, and sleep disordered breathing. In addition to pharmacological management strategies, lifestyle interventions will be discussed to optimize energy balance and AT loss, including dietary and exercise interventions. The need for future research on satiety, body composition assessment, dietary intake, and exercise interventions to reduce neurogenic obesity after SCI will be discussed.
Speaker: David R. Gater, Jr., MD PhD MS – University of Miami Miller School of Medicine Department of PM&R
Speaker: Gary J. Farkas, PhD – U Miami Miller School of Medicine
Speaker: Alicia Sneij, PhD, RDN – U Miami Miller School of Medicine