Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2019; 7(17): 2427-2437
Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2427
Dietary manipulation and testosterone replacement therapy may explain changes in body composition after spinal cord injury: A retrospective case report
Ashraf S Gorgey, Robert M Lester, Mina P Ghatas, Sakita N Sistrun, Timothy Lavis
Ashraf S Gorgey, Robert M Lester, Mina P Ghatas, Timothy Lavis, Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, Richmond, VA 23249, United States
Ashraf S Gorgey, Timothy Lavis, Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23249, United States
Sakita N Sistrun, Bionutrition Service, Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA 23249, United States
Author contributions: Gorgey AS provide funding, conduct the study and draft the manuscript; Lester RM helped in data collection, data analysis and drafting the manuscript; Ghatas MP helped in data analysis and drafting the manuscript; Sistrun SN served as a Dietician on the study and helped analyzing dietary; Lavis T served as medical personnel and helped screening and monitoring the subject throughout the study.
Supported by Department of Veteran Affairs, Veteran Health Administration, Rehabilitation Research and Development Service, No. 1IK2RX000732-01A1.
Institutional review board statement: Hunter Holmes McGuire VAMC and Virginia Commonwealth University approved the current study.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Data sharing statement: Data will be available upon personal resquest to the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ashraf S Gorgey, BSc, MSc, PhD, Academic Fellow, Academic Research, Associate Professor, Physiotherapist, Research Scientist, Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, Spinal Cord Injury and Disorders Service, 1201 Broad Rock Boulevard, Richmond, VA 23249, United States.
Telephone: +1-804-6755000Fax: +1-804-6755223
Received: March 27, 2019
Peer-review started: March 28, 2019
First decision: August 1, 2019
Revised: August 15, 2019
Accepted: August 25, 2019
Article in press: August 26, 2019
Published online: September 6, 2019

Reduced level of physical activity, high-fat diet and skeletal muscle atrophy are key factors that are likely to contribute to deleterious changes in body composition and metabolic following spinal cord injury (SCI). Reduced caloric intake with lowering percentage macronutrients of fat and increasing protein intake may likely to improve body composition parameters and decrease ectopic adiposity after SCI.


To highlight the effects of dietary manipulation and testosterone replacement therapy (TRT) on body composition after SCI


A 31-year-old male with T5 SCI was administered transdermal TRT daily for 16 wk. Caloric intake and percentage macronutrients were analyzed using dietary recalls. Magnetic resonance imaging and dual-energy x-ray absorptiometry were used to measure changes in body composition.


Caloric intake and fat percentage were reduced by 445 kcal/d and 6.5%, respectively. Total body weight decreased by 8%, body fat decreased by 29%, and lean mass increased by 7%. Thigh subcutaneous adipose tissue cross-sectional area was reduced by 31%.


Manipulation of caloric intake, fat percentage, and protein percentage may have influenced body composition after SCI.

Keywords: Spinal cord injury, Diet, High-protein, Low-fat, Nutrients, Basal metabolic rate, Case report

Core tip: Reduction in caloric intake with low-fat and high-protein diet may appear as a reasonable strategy to effectively lose weight and fat mass in persons with spinal cord injury. The supplement of testosterone replacement therapy (TRT) may offset for potential loss in lean mass and reduction in basal metabolic rate that is commonly observed in weight loss program. The combination of dietary manipulation and TRT is a feasible approach and does not appear to be accompanied with any side effects.