Determinants of cardiometabolic health in spinal cord injury.

Raguindin, Peter Francis (2022). Determinants of cardiometabolic health in spinal cord injury. (Unpublished). (Dissertation, University of Bern, the Faculty of Medicine and the Faculty of Human Sciences)

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Background
Individuals with spinal cord injury (SCI) are at high-risk for cardiovascular diseases because of the clustering of risk factors, namely, dyslipidemia, obesity, and diabetes. However, SCI-specific determinants for cardiovascular diseases were rarely investigated.

Aim/s
In my thesis, I investigated the role of injury level on the cardiometabolic risk profile (Article 1 and 2). To determine how early the deleterious changes occur, I explored the longitudinal changes over the subacute phase of injury (Article 3). Furthermore, I studied the association of rehabilitation outcomes with cardiometabolic risk to prioritize which individuals need more intensive screening on discharge (Article 4). Furthermore, I provided prospects for cardiometabolic research in SCI (Article 5 and 6).

Methods
In Article 1 and 2, we systematically searched 5 electronic databases for observational studies reporting cardiometabolic risk according to injury level. We extracted blood pressures, lipid profiles, glucose metabolism parameters, fat composition, anthropometrics, and inflammatory markers. We pooled study estimates using the random-effects model. In Article 3, we determined the longitudinal changes using Swiss Spinal Cord Injury cohort, a collaboration of four SCI-rehabilitation specialized centers in Switzerland. We included adults with traumatic SCI and compared the cardiometabolic risk profile upon admission and discharge to rehabilitation. Linear mixed-models using random-slope to determine the changes over time and the association of injury characteristics to cardiometabolic risk. In Article 4, we performed cross-sectional and longitudinal analysis on the association of rehabilitation outcomes (anthropometric measures, respiratory function, muscle strength, spasticity, overall functioning, and mobility) with cardiometabolic risk (cardiovascular risk score, dyslipidemia, impaired fasting glucose). Finally, in Article 5 and 6, we reviewed the literature on sex/gender reporting disparity in SCI research and provided detailed steps for performing a meta-analysis on observational data.

Results
In the meta-analysis of 3,878 participants, individuals with tetraplegia had lower high-density lipoprotein (-1.7 mg/dL, 95% CI -3.3, -0.2) compared to paraplegia (Article 1). In another meta-analysis of 4872 individuals, individuals with tetraplegia had a higher fat percentage (weighted mean difference (WMD) 1.9%, 95% CI 0.6, 3.1) and a lower lean mass (WMD -3.0 kg, 95% CI -5.9, -0.2) compared to those with paraplegia (Article 2). Those with tetraplegia also had higher indicators of central adiposity (WMD, visceral adipose tissue area 0.24 dm2 95% CI 0.05, 0.43 and volume 1.05 L 95% CI 0.14, 1.95). In our longitudinal analysis of 258 individuals with traumatic SCI in the Swiss SCI cohort, we observed an increase in cholesterol and HDL-C and lipid ratio when comparing the beginning and end of rehabilitation (Article 3). At discharge, one-third of study participants were classified as moderate to high risk of CVD, 64% were overweight, and 39.45% had a cardiometabolic syndrome (Article 3). For rehabilitation outcomes, there is improvement in respiratory function, handgrip strength, and functional independence during initial rehabilitation (Article 4). Individuals with higher force vital capacity (>2.72 L) and peak expiratory flow (>3.4L/min) had 0.16 mmol/L and 0.14 mmol/L higher HDL compared to those with lower respiratory function, respectively. Individuals with higher mobility scores (>12.5) and functional independence scores (>74) had 0.21 mmol/L and 0.18 mmol/L higher HDL compared to those with lower scores (Article 4).

Conclusion
I showed that higher injury level is associated with poorer lipid profile and higher adiposity (Article 1 and 2). Lipid profiles improved during rehabilitation, albeit injury characteristic does not play a role in longitudinal changes (Article 3). Finally, better cardiometabolic profiles are associated with higher respiratory function, more mobility and functioning, and leaner anthropometric measures (Article 4). Future research should adopt a more gender-sensitive approach (Article 5). In addition, we suggest more systematic reviews in the field to increase the precision of effect estimates, considering the low incidence of injury (Article 6).

Item Type:	Thesis (Dissertation)
Division/Institute:	04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM) 04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition
Graduate School:	Graduate School for Health Sciences (GHS)
UniBE Contributor:	Raguindin, Peter Francis, Muka, Taulant, Glisic, Marija, Bally, Lia Claudia
Subjects:	600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services
Language:	English
Submitter:	Doris Kopp Heim
Date Deposited:	23 Mar 2023 15:21
Last Modified:	23 Mar 2023 23:27
Additional Information:	PhD in Health Sciences (Epidemiology and Biostatistics)
URI:	https://boris.unibe.ch/id/eprint/180564