Obesity, Spinal Cord Injury
Conditions
Brief summary
Spinal cord injury (SCI) causes paralysis and muscle atrophy and leads to weight gain and obesity. Obesity directly contributes to functional impairment and cardiometabolic dysfunction. There is a critical need to reduce the growing prevalence of obesity and cardiometabolic disease after SCI. My overall objective in this project is to gather crucial feasibility data on time restricted eating (TRE), a novel form of intermittent fasting. TRE is a straightforward method to induce weight loss without the need for calorie counting. TRE allows individuals to eat all their daily calories in a time restricted window and fast outside that window. A growing body of literature supports the safety and efficacy of TRE. Given the feasibility, high adherence, and substantial benefits of TRE in able-bodied individuals, it is important to test TRE to determine its feasibility in Veterans with SCI. The investigators will first test this intervention in Veterans with paraplegia, who are at greatest risk of muscle-joint upper body injury given the need to support body weight during activity. The investigators will determine adherence to a TRE window for 6-weeks duration in a convenience sample of Veterans with paraplegia and obesity. Based on the expected outcomes of good adherence, this study will lay the groundwork for future work by informing the design of a randomized controlled trial to test the efficacy of TRE to facilitate weight loss and improve function.
Interventions
BEHAVIORALTime Restricted Eating
Time Restricted Eating Protocol: Subjects will be instructed to limit caloric consumption to a 10-hour TRE window. The window start-time will be self-selected (individualized). During the eating window, subjects will not be restricted on types or quantities of food consumed, and will be advised to continue their usual diets. Subjects will not be required to monitor their caloric intake. During the fasting period, subjects will be encouraged to stay hydrated and drink ample water. Outside the designated eating window, subjects are only permitted to consume medication, water, or zero-calorie herbal drinks such as unsweetened tea or black coffee.
Sponsors
VA Office of Research and Development
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Intervention model description
Intervention: This is a single-arm study in a convenience sample of Veterans with paraplegia and obesity. Research Design: Those with mean eating windows of at least 10 hours per day will be eligible to participate in the TRE intervention. Tests for adherence (food log) will be collected.
Eligibility
Sex/Gender
ALL
Age
18 Years to 89 Years
Healthy volunteers
No
Inclusion criteria
* Veteran * A member of the Spinal Cord Injury/Disorder (SCI/D) registry through the Syracuse VA, including both hub and spoke sites * A qualifying diagnosis of SCI within the SCI/D registry * Neurologic level of injury from T1 to S5, based on most recent Status Update or American Spinal Injury Association Impairment Scale (ASIA) examination, or a diagnosis of a hereditary form of paraplegia (such as familial spastic paraplegia or hereditary spastic paraplegia) * ASIA Impairment Scale grade A-D * Chronic SCI (\> 1 year from date of SCI or diagnosis of SCI) * BMI \> 22 - the BMI used to diagnose obesity in individuals with SCI * Mean eating window of at least 10 hours per day
Exclusion criteria
* Females who are pregnant (tested via urinary human chorionic gonadotropin (hCG)), planning to become pregnant in the next 6 months, or breast-feeding * A member of the SCI/D registry through the Syracuse VA, with a qualifying diagnosis of MS or ALS * Diagnosis of heart failure * Diagnosis of diabetes mellitus, type 1 * Diagnosis of diabetes mellitus, type 2, and on insulin or other antidiabetic agent with high incidence of hypoglycemia o Of note, antidiabetic agents with low incidence of hypoglycemia are: metformin, Glucagon-like peptide-1 (GLP-1) receptor agonists, Sodium-glucose cotransporter-2 (SGLT2) inhibitors, Dipeptidyl peptidase 4 (DPP-4) inhibitors, alpha glucosidase inhibitors, thiazolidinediones (as discussed with VA pharmacist) * Diagnosis of End Stage Renal Disease * Diagnosis of dementia * Diagnosis of orthostatic hypotension and prescribed midodrine or fludrocortisone * History of syncopal episode in the month prior to the study * History of significant weight loss (\> 10% body weight) in the month prior to the study * History of eating disorders (e.g., anorexia or bulimia) within the last five years, or clearance from a mental health provider * History of active suicidal ideation in the last six months, or clearance from a mental health provider * Currently prescribed weight loss medication (e.g., liraglutide) * Currently prescribed corticosteroids * Current acute medical issues including cancer, sepsis, advanced liver failure, porphyria, or uncontrolled hyperthyroidism
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in the daily eating window | Measured weekly from baseline to week 6 | Measured by questionnaire (assesses the time the participant started and stopped eating each day) |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORGeoffrey V Henderson, MD
Syracuse VA Medical Center, Syracuse, NY
Outcome results
None listed