Farkas Gary J, Caldera Lizeth J, Hodgkiss Daniel D, Mitchell Jessica R, Pelaez Thomas F, Cusnier Maxwell A, Cole Alex J, Daniel Scott G, Farrow Matthew T, Gee Cameron M, Kincaid-Sharp Eric A, Green Logan Andrew Malcolm, McMillan David W, Nightingale Tom E, Perdue Brieanna, Portes Pauline, Walson Francis T, Volmrich Alyssa M, Reynolds John M, Nash Mark S, Gater David R, Berg Arthur S
Department of Physical Medicine and Rehabilitation, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
The Miami Project to Cure Paralysis, Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
J Clin Med. 2025 Apr 22;14(9):2872. doi: 10.3390/jcm14092872.
: This systematic review with meta-analysis compared cardiometabolic syndrome (CMS) in adults with chronic (≥1 year) spinal cord injury (SCI) to non-SCI individuals (controls) and athletes, analyzing the effect of specific injury characteristics and exploring temporal and geographical trends. : Ovid Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science were searched from inception to September 2024. Adults with chronic SCI were included based on observational and baseline data derived from experimental studies. Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields assessed quality. Weighted means with 95% bootstrapped confidence intervals (CI) were computed for risk stratification. Group differences were assessed using random effects meta-analysis, calculating weighted mean differences with 95% bootstrapped CI. Temporal and geographical trends were evaluated with linear regression based on sample-size-weighted distributions and relevant covariates. : Of 31,163 identified records, 471 studies were included ( ≤ 31,782 SCI participants). CMS was present in men with SCI, paraplegia, tetraplegia, and injuries above T6; men with complete SCI (AIS A); and men and women with motor-complete SCI (AIS A-B). Compared to controls, adults with SCI had a lower body mass index (BMI), higher total and visceral fat, and worse lipid and carbohydrate profiles, including increased insulin resistance (IR). Tetraplegia was associated with greater visceral fat, poorer glycemic control, and lower BMI, insulin sensitivity, high-density lipoprotein-cholesterol (HDL-C), and triglycerides than paraplegia. Motor-complete SCI had lower BMI, HDL-C, and fasting glucose than motor-incomplete injuries. Injuries above T6 had lower blood pressure and higher fasting insulin levels than those below T6. Athletes with SCI had a lower BMI, fat mass, and fasting glucose, and higher systolic blood pressure than non-athletes with SCI, but frequently presented with obesity and carbohydrate dysfunction. Temporal analysis revealed increasing obesity trends and improved systolic blood pressure, while other CMS risk factors remained unchanged. We also identified global variations in obesity, lipids, blood pressure, and carbohydrate patterns. : With a large sample, we revealed a widespread cardiometabolic burden in chronic SCI, even among athletes. Specifically, obesity, IR, and hypoalphalipoproteinemia worsened with increasing injury severity, alongside rising obesity trends and geographic disparities in risk profiles. These patterns highlight the evolution of what was deemed an epidemic into a global cardiometabolic pandemic.
本项带有荟萃分析的系统评价将慢性（≥1年）脊髓损伤（SCI）成人患者的心脏代谢综合征（CMS）与非SCI个体（对照）及运动员进行了比较，分析了特定损伤特征的影响，并探讨了时间和地理趋势。检索了Ovid Medline、Embase、Cochrane、CINAHL、Scopus和Web of Science数据库，检索时间范围从建库至2024年9月。根据实验研究得出的观察性数据和基线数据纳入慢性SCI成人患者。采用《多领域原发性研究论文质量评估标准》评估质量。计算风险分层的加权均值及95%自抽样置信区间（CI）。采用随机效应荟萃分析评估组间差异，计算加权平均差及95%自抽样CI。基于样本量加权分布和相关协变量，采用线性回归评估时间和地理趋势。在31163条检索到的记录中，纳入了471项研究（≤31782名SCI参与者）。CMS见于患有SCI的男性、截瘫患者、四肢瘫患者以及T6以上损伤的患者；患有完全性SCI（AIS A）的男性；以及运动完全性SCI（AIS A - B）的男性和女性。与对照组相比，SCI成人患者的体重指数（BMI）较低，总脂肪和内脏脂肪较高，脂质和碳水化合物谱较差，包括胰岛素抵抗（IR）增加。与截瘫相比，四肢瘫与更多的内脏脂肪、更差的血糖控制以及更低的BMI、胰岛素敏感性、高密度脂蛋白胆固醇（HDL - C）和甘油三酯相关。运动完全性SCI的BMI、HDL - C和空腹血糖低于运动不完全性损伤。T6以上损伤的患者血压较低，空腹胰岛素水平高于T6以下损伤的患者。与非运动员SCI患者相比，运动员SCI患者的BMI、体脂和空腹血糖较低，收缩压较高，但经常出现肥胖和碳水化合物功能障碍。时间分析显示肥胖趋势增加，收缩压有所改善，而其他CMS危险因素保持不变。我们还发现了肥胖、脂质、血压和碳水化合物模式的全球差异。通过大量样本，我们揭示了慢性SCI中广泛存在的心脏代谢负担，即使在运动员中也是如此。具体而言，肥胖、IR和低脂蛋白血症随着损伤严重程度的增加而恶化，同时肥胖趋势上升，风险特征存在地理差异。这些模式凸显了一种被视为流行病的情况演变成全球心脏代谢大流行的过程。
