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We evaluate the association of body composition and injury level with cardiometabolic disease (CMD) risk factors. Sixty-two individuals (69% male, 31% female) with chronic SCI (mean duration 7.4, SD\u2009<jats:italic>\u00b1<\/jats:italic>\u20095.8 years) were recruited. Mean age of participants was 34.4\u2009<jats:italic>\u00b1<\/jats:italic>\u200912.1 years with BMI of 23.8\u2009<jats:italic>\u00b1<\/jats:italic>\u20095, while 64% had BMI\u2009&lt;\u200925 and 11% &gt;30. Total and percent truncal fat correlated positively (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) with serum triglycerides, non-high-density lipid cholesterol, c-reactive protein (CRP), oral glucose tolerance test (OGTT), and measures of insulin resistance. Those with obesity in SCI (defined as BMI\u2009<jats:italic>\u2265<\/jats:italic>\u200922) had increased total and trunk mass and fat percentage, unfavorable lipid profiles and evidence of insulin insensitivity. Total fat was associated with CMD risk factors, including insulin resistance (OGTT 60\u00a0min <jats:italic>r<\/jats:italic>\u2009=\u20090.47, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05; homeostasis model assessment [HOMA] <jats:italic>r<\/jats:italic>\u2009=\u20090.62, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), serum triglycerides (<jats:italic>r<\/jats:italic>\u2009=\u20090.31, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), and inflammation (CRP <jats:italic>r<\/jats:italic>\u2009=\u20090.43, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Obesity in SCI related to higher CMD risk, while time since injury and injury level (paraplegia versus tetraplegia) did not. Future studies may evaluate roles of nutrition, exercise, sleep-promotion, and pharmaceuticals to lower neurogenic obesity and chronic CMD risk.<\/jats:p>","DOI":"10.1038\/s41598-025-13593-0","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T15:36:12Z","timestamp":1754667372000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Obesity in chronic spinal cord injury is associated with poorer body composition and increased risk of cardiometabolic disease"],"prefix":"10.1038","volume":"15","author":[{"given":"Nicholas","family":"Dietz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell","family":"Boakye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin F.","family":"Bjurstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Ugiliweneza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirish","family":"Barve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriprakash","family":"Mokshagundam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"issue":"9","key":"13593_CR1","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1016\/j.spinee.2021.05.014","volume":"21","author":"MD Peterson","year":"2021","unstructured":"Peterson, M. 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