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
Research background

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.

Research motivation

Currently, there is no standard of care of established evidence on how to improve body composition parameters and to reduce ectopic adiposity after SCI.

Research objectives

To highlight the necessary dietary adjustments as far as caloric and macronutrient intakes responsible for improving body composition and metabolic profile following participation in a 16 wk clinical trial of administering low-dose testosterone replacement therapy in a male with SCI.

Research methods

We, retrospectively, tracked the dietary habits and body composition parameters in a 31-year-old male with motor-complete T5 SCI after administering low-dose testosterone replacement therapy (TRT) for 16 wk. Detailed body composition was evaluated via dual energy x-ray absorptiometry and magnetic resonance imaging. Participant was asked to turn in weekly 5 d dietary recalls to measure total energy intake, percentage carbohydrate, percentage fat, percentage protein, and total soluble fiber intake.

Research results

Lowering caloric intake by 25% and fat intake by 6.5% resulted in decreased body weight, total and regional body fat mass and ectopic adiposity. Both lean mass and BMR remained physiologically unchanged following the 16 wk intervention.

Research conclusions

The current case report highlighted the significance of reducing caloric intake and manipulating macronutrients with TRT on the changes in total and regional body composition in a male with SCI.

Research perspectives

The current case report may serve as supporting evidence for future clinical trial that may target manipulation of dietary intake with and without ergogenic aids similar to exercise and TRT to improve cardio-metabolic profile in persons with SCI.